Reminder: Use Anesthesia Modifiers Appropriately
National Government Services requires placement of pricing modifiers in the first modifier position to process your anesthesia claims correctly.
Modifiers for anesthesia pricing must be placed correctly on claims submitted to NGS. Claims submitted incorrectly will suspend and require manual intervention causing delays in claims processing and potential processing errors.
We are asking you to review your billing practices and ensure that you are appending your anesthesia modifiers in the first position field to the right of the procedure code on Item 24D of the CMS-1500 claim form or the electronic equivalent.
| The anesthesia pricing modifiers listed below shall be listed in first modifier position to ensure correct reimbursement. | When submitting preventive screening modifiers, we ask that these be appended in the second modifier position, after the pricing modifiers listed to the left. | When submitting informational modifiers, please append in the third modifier position, in conjunction with a pricing anesthesia modifier(s) and preventative modifier(s). |
|---|---|---|
| AA: Anesthesia services personally performed by an anesthesiologist. AD: Medical supervision by an anesthesiologist: more than 4 concurrent anesthesia procedures. QK: Medical direction of 2, 3, or 4 concurrent anesthesia procedures involving qualified individuals QX: CRNA service with medical direction by an anesthesiologist. QY: Anesthesiologist medically directs one CRNA. |
33: Preventive Services: When the primary purpose of the service is the delivery of an evidence based service in accordance with a USPSTF A or B rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory). This modifier is appended to anesthesia CPT code 00810, which will waive the Medicare deductible and coinsurance. PT: A colorectal cancer screening test which led to a diagnostic procedure. This modifier is appended to anesthesia CPT code 00810, which will waive the Medicare deductible. |
QS: MAC G8: MAC for deep complex complicated or markedly invasive surgical procedures and may be used in lieu of modifier QS. G9: MAC for a patient who has a history of severe cardiopulmonary condition and may be used in lieu of modifier QS. GC: Performed by a resident under the direction of a teaching physician: provider must also use one of the other pricing modifiers in the first modifier position. AQ: Services provided in a HPSA. |
Posted 6/25/2019