HCPCS Modifier QY
Medical direction of one qualified nonphysician anesthetist by an anesthesiologist.
Guidelines and Instructions
- This modifier may only be submitted with anesthesia procedure codes (i.e., CPT codes 00100 through 01999). 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 this modifier first
- Performs a pre-anesthetic exam and evaluation (must be documented in the patient's medical records)
- Prescribes the anesthesia plan
- Personally participates in the most demanding procedures in the anesthesia plan, including, if applicable, induction and emergence (physician presence must be documented in the patient's medical record)
- Ensures that any procedures in the anesthesia plan that he or she does not perform are performed by a qualified individual
- Monitors the course of anesthesia administration at frequent intervals (physician presence during some portion of anesthesia monitoring must be documented in the patient's medical records)
- Remains physically present and available for immediate diagnosis and treatment of emergencies
- Provides indicated post-anesthesia care (must be documented in the patient's medical records)
- A physician can direct two, three or four concurrent procedures involving qualified individuals. The qualified individuals may be CRNAs, AAs, interns, residents or a combination of these individuals.
- Medical direction rules apply when a physician directs two concurrent procedures and each of which involves a student nurse anesthetist
- Medical direction rules also apply when a physician directs two concurrent procedures and one of which involves a student nurse anesthetist and the other of which involves a CRNA, AA, resident or intern
- Special notes for anesthesiologists in group practice:
- One physician member may perform the pre-anesthetic exam and evaluation while another physician member performs the other required activities
- One physician member may perform the indicated post-anesthesia care while another physician member of the group performs the other portions of the anesthesia service
- The medical record must indicate that the services were provided by a physician and must identify the specific physician that performed them
- CMS Internet Only Manuals, Pub. 100-04, Chapter 12 (PDF, 1.10 MB)
- Definitions of personally performed, medically directed and medically supervised: Section 50
- Definition of concurrent procedures: Section 50.C
- Anesthesia claims modifiers: Section 50.I