FYI - Anesthesia Payment Modifiers
Physician Anesthesia Services
When the anesthesiologist personally performed services.
Report anesthesia services personally performed by the anesthesiologist with modifier AA.
Medically Directed
When the anesthesiologist is involved in specific aspects of anesthesia services performed by other qualified individuals, the services are considered to be "medically directed."
*Qualified individuals includes: CRNAs, anesthesiologists' assistants, residents, or combinations of these individuals.
*Specific CMS requirements and conditions for medically directed anesthesia services must be met.
*The anesthesiologist may not perform other services while medically directing anesthesia procedures.
Medical direction of one qualified nonphysician anesthesia procedure. Report medical direction of one CRNA anesthesia procedure with modifier QY.
Medical direction of 2-4 concurrent anesthesia procedures. When two to four concurrent anesthesia procedures are medically directed, report with modifier QK.
Medically supervised
When the anesthesiologist is involved in furnishing more than four procedures concurrently or is performing other services while directing the concurrent procedures, the services are considered to be "medically supervised."
*CMS standards are used to determine if other services were performed while directing concurrent procedures.
Report medically supervised anesthesia services with modifier AD.
Teaching services
Claims for direction of residents and/or student nurse anesthetists should be submitted with proper modifiers attached to the anesthesia codes.
*In order to bill for anesthesia procedures, the teaching physician must be present during all critical and key portions of the procedure and be immediately available to furnish services during the entire procedure.
Services by the teaching physician when directing a single resident or student nurse:
*If the teaching physician was directing a resident, report with modifier AA and also append modifier GC.
*If the teaching physician was directing one qualified nonphysician anesthetist (for example: CRNA, anesthesiologist's assistant, student), report with modifier QY.
Services by the teaching physician when directing two concurrent anesthesia procedures:
If directing two residents performing concurrent cases, report with modifiers AA and GC.
*If directing one resident and one other qualified nonphysician anesthetist performing concurrent cases report the direction of the resident with modifiers AA and GC.
Report the direction of the qualified nonphysician anesthetist with modifier QK.
*If directing two qualified nonphysician anesthetists performing concurrent cases, report the direction of both cases with modifier QK.
Services by the teaching physician when directing three, or four residents, student nurse anesthetists, or CRNAs concurrently, must be submitted with modifier QK.
CRNA Services
CRNA personally performed the full anesthesia service without medical direction or supervision by a physician.
Report personally performed CRNA anesthesia services with modifier QZ.
CRNA anesthesia services provided with medical direction by a physician
Report modifier QX for physician directed CRNA services.
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