Description
Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals.

Guidelines/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
Physician services may be reimbursed at the medically directed rate if the physician medically directs qualified individuals in two, three or four concurrent cases and performs the following activities:
  • Performs a pre-anesthetic exam and evaluation (must be documented in the patient's medical record)
  • Prescribes the anesthesia plan
  • Personally participates in the most demanding procedures in the anesthesia plan, including 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 anesthetist
  • 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)
Additional Guidelines for Medically Directed Services
  • 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

Reference

Contact Palmetto GBA JJ Part B Medicare

Provider Contact Center: 877-567-7271

Email JJ Part B

Contact a specific JJ Part B department


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