Reimbursement for anesthesia services is calculated in part based on modifiers submitted with these services. There have been no changes to Medicare policy and guidelines regarding documentation and reimbursement for these services.
Modifiers listed in the chart below may only be submitted with anesthesia procedure codes (i.e., CPT codes 00100-01999). CPT codes 01995 or 01996 are not recognized for time units and should not be submitted with time units in the quantity billed field.
Anesthesia 'Medical Direction' Modifiers
|
HCPCS Modifier
|
Description
|
|
AA
|
Anesthesia services personally performed by anesthesiologist
|
|
AD
|
Medical supervision by a physician: more than four concurrent anesthesia procedures
|
|
QK
|
Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals
|
|
QX
|
CRNA/AA with medical direction by a physician
|
|
QY
|
Medical direction of one CRNA/AA by an anesthesiologist
|
|
QZ
|
CRNA without medical direction by physician
|
Monitored Anesthesia Care Modifiers
|
HCPCS Modifier
|
Description
|
|
G8
|
Monitored anesthesia care (MAC) for deep complex, complicated or markedly invasive surgical procedure
|
|
G9
|
Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition
|
|
QS
|
Monitored anesthesia care service
|
NOTE: Submit the appropriate modifier to indicate 'monitored anesthesia care' in addition to the medical direction modifier. Submit only one monitored anesthesia care modifier per service. Submit the medical direction modifier first, followed by the monitored anesthesia care modifier if appropriate.
Guidelines/Instructions:
- Payment for services that meet the definition of 'personally performed' is calculated based on the base units (as defined by CMS) and time, in increments of 15-minute units
- Payment for services that meet the definition of 'medically directed' or 'without medical direction' is calculated based on the base units (as defined by CMS) and time, in increments of 15-minute units. Payment for services that meet the definition of 'medically directed' is based on 50 percent of the 'personally performed' rate.
- If you are submitting multiple modifiers, submit the medical direction modifier first, followed by any additional modifiers that are needed
Reference:
- CMS Medicare Claims Processing Manual (Pub. 100-04), Chapter 12 (PDF, 902 KB)
- Definitions of personally performed, medically directed and medically supervised: Section 50
- Definition of concurrent procedures: Section 50J
- Anesthesia modifiers: Section 50K
- Base units for anesthesia services: following Section 50K: Exhibit 1
- Additional information regarding anesthesia modifiers is available in the Palmetto GBA Modifier Lookup tool