Anesthesia Services: Anesthesiologist Assistants (AAs) and the QZ HCPCS Modifier

The QZ HCPCS modifier indicates a Certified Registered Nurse Anesthetist (CRNA) service performed without medical direction.

An anesthesiologist’s assistant (AA) means a person who:

• Works under the direction of an anesthesiologist;
• Is in compliance with all applicable requirements of state law, including any licensure requirements the state imposes on nonphysician anesthetists; and
• Is a graduate of a medical school-based anesthesiologist assistant educational program that 
  • Is accredited by the Committee on Allied Health Education and Accreditation; and
  • Includes approximately two years of specialized basic science and clinical education in anesthesia at a level that builds on a premedical undergraduate science background

A CRNA is a registered nurse who:

• Is licensed as a registered professional nurse by the state in which the nurse practices;
• Meets any licensure requirements the state imposes with respect to nonphysician anesthetists;
• Has graduated from a nurse anesthesia educational program that meets the standards of the Council on Accreditation of Nurse Anesthesia Programs; and
• Meets the following criteria: Has passed a certification examination of the Council on Certification of Nurse Anesthetists or the Council on Recertification of Nurse Anesthetists; or
• Is a graduate of a nurse anesthesia educational program that meets the standards of the Council of Accreditation of Nurse Anesthesia Educational Programs, and within 24 months of graduation, has passed a certification examination of the Council on Certification of Nurse Anesthetists or the Council on Recertification of Nurse Anesthetists

CRNAs and AAs may submit claims to Medicare directly for their services or have payment made to an employer or an entity under which they have a contract. This could be a hospital, physician or ambulatory surgical center.

Guidelines/Instructions for the QZ HCPCS Modifier

• 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 "personally performed" is based on the base units as defined by CMS and time, in increments of 15-minute units.
• If you are submitting multiple modifiers, submit this modifier first

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
  • Anesthesia claims modifiers: Section 50.1
  • Billing modifiers for qualified nonphysician anesthetists: Section 140.3.3
  • Monitored Anesthesia Care 50.H
• Additional information regarding anesthesia modifiers is available in the Palmetto GBA Modifier Lookup Tool