Anesthesia: Modifier Submission


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 (e.g., CPT codes 00100–01999). CPT codes 01995 and 01996 are not recognized for time units and should not be submitted with time units in the quantity billed field.

Note: For payment purposes, qualified nonphysician anesthetists include both Certified Registered Nurse Anesthetists (CRNAs) and anesthesiologists' assistants (AAs).

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
Qualified nonphysician anesthetist services with medical direction by a physician
QY
Medical direction of one qualified nonphysician anesthetist by an anesthesiologist
QZ
CRNA service 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: The QS HCPCS modifier can be used by a physician or a qualified nonphysician anesthetist and is for informational purposes. Providers must report actual anesthesia time and one of the payment modifiers on the claim.

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 and 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

References

  • CMS Medicare Claims Processing Manual (PDF, 1.12 MB) (Pub. 100-04), Chapter 12
    • Definitions of personally performed, medically directed and medically supervised: Section 50
    • Definition of concurrent procedures: Section 50.C
    • Monitored Anesthesia Care 50.H 
    • Anesthesia claims modifiers: Section 50.I
    • Billing Modifiers for qualified nonphysician anesthetists: Section 140.3.3 
  • Additional information regarding anesthesia modifiers is available in the Palmetto GBA Modifier Lookup Tool




Last Updated: 11/23/2020