MODIFIERS - CPT

The CPT system contains thirty-one modifiers. Modifiers –50 (bilateral), -52(when used to
indicate a discontinued procedure), -53, -73, and –74 apply only to surgical procedures. General
guidelines for using modifiers appear in the form of questions to be considered. If the answer to
any of the following is yes, then it is appropriate to use the applicable modifier.
 Will the modifier add more information regarding the anatomic site of the procedure?
 Will the modifier help to eliminate the appearance of duplicate billing?
 Would a modifier help to eliminate the appearance of unbundling?

All modifiers are listed in Appendix A of CPT. CPT modifiers and their definitions are explained
below.

-21 Prolonged Evaluation and Management Services

This modifier reports services that take more time or are greater than the highest level
E/M code in a particular category. This modifier is used with codes such as 99205,
99215, 99223, 99233, 99245, 99255, etc.

-22 Unusual Services

The Unusual Services modifier has conceptually distinct uses in CPT. Its primary purpose
is to denote circumstances for which a procedure or service required an "unusual"
amount of time or effort to perform. As such, a higher fee is charged. A word of caution
regarding the use of the unusual service modifier -- its use implies that the procedure or
service was distinctly more time-consuming or difficult to perform. When using the
modifier you must also send a special report to the insurance carrier that describes the
unusual nature of the service and justifies the additional charge. Even when justified, it
may be difficult at best to obtain higher than normal reimbursement from the majority of
payers.

Consider a surgical procedure that typically requires one to two hours to

perform. Reimbursement from payers will be the same whether the procedure
takes one or two hours. Why? Reimbursement averages out across patients over
time. The use of the unusual services modifier would be inappropriate if the
procedure took two hours, just as use of the reduced service modifier would not
be appropriate if the procedure took one hour.

However, use of the unusual services modifier would be more appropriate with
the above hypothetical surgery if the operation was very difficult and required
three hours to perform because the patient was obese.
The -22 modifier has other specific uses in CPT

For example, in the Psychiatry section, the unusual services modifier is

sometimes used to communicate that the patient was seen for a period greater
than is customary.

Attachment A
MODIFIERS – CPT
23 Unusual Anesthesia

Under some circumstances general anesthesia is given when normally either a local or no
anesthesia is provided.

For example, performing a cystoscopy on a three-year-old child would likely

require a general anesthesia, whereas the same procedure on an adult would
not. Thus, use of a general anesthetic when performing a cystoscopy is an
example of unusual anesthesia.

Insurance companies will want to know why the anesthesia was required. Therefore,
when submitting the unusual anesthesia modifier be sure to include a report that focuses
on the circumstances which required that the patient receive a general anesthetic. The
use of this modifier is generally restricted to anesthesiologists.

-24 Unrelated Evaluation and Management Service by the Same Physician During
a Postoperative Period

This modifier allows the physician to report that a service was performed during a
postoperative or global period for a reason(s) unrelated to the original procedure.
Modifier –24 should be billed with an E/M code. Do not use this modifier with a surgical
code. The diagnosis code used must support the service.

For example, a patient who is being followed by her gynecologist during a

pregnancy comes in for an additional visit because she has developed acute
bronchitis. The bronchitis is unrelated to the pregnancy and necessitated an
additional visit over and above her regular pregnancy check-ups. The E/M code
for the visit is billed to the insurance carrier with a –24 modifier and the
diagnosis code used is 466.0 for Acute Bronchitis.

-25 Significant Separately Identifiable Evaluation and Management Service by the

Same Physician on the Same Day of the Procedure or Other Service

This modifier indicates that on a day a procedure or service identified by a CPT code was
performed, the patient’s condition required a significant, separately identifiable E/M
service above and beyond the usual preoperative and postoperative care associated with
the procedure that was performed. Assign the proper E/M code and amount as
appropriate for the service rendered.

that resulted The E/M service may be prompted by the symptom or condition for which
the procedure and/or service was provided. As such, different diagnoses are not
required for reporting of the E/M services on the same date. This circumstance may be
reported by adding the modifier –25 to the appropriate level of E/M service. Note: This
modifier is not used to report an E/M service in a decision to perform surgery.
 Attachment A
MODIFIERS – CPT

-26 Professional Components

Many listed procedures consist of both technical and professional components. Technical
components include such things as equipment, technician time, and supplies that are
used in the performance of a procedure. The professional component refers to the
physician's time, skill, and judgment in interpreting the results of tests and procedures.

For example, consider the simple chest X-ray described in code 71010. If the
radiograph of the patient's chest is taken in the physician's office utilizing both
the physician's equipment and staff, the charge for the chest X-ray will include
the use of the equipment, film, chemicals, and staff time as well as the
physician's time to interpret the X-ray itself. As such, the charge for code 71010
will include both the technical and professional components.

In contrast to the above example, suppose that the physician does not have X-ray
equipment, and refers the patient to a local hospital where the "picture" will be taken.
The hospital, in turn, sends the X-ray to a radiologist who interprets the chest X-ray The
radiologist would bill the patient for interpreting the radiograph only and use the "-26"
professional component modifier as shown below.

71010-26 Interpretation, single view chest X-ray

By the use of this modifier, the radiologist can restrict his or her charge to the
professional component -- the interpretation.

-27 Multiple Outpatient Hospital E/M Encounters on the Same Date

For hospital outpatient reporting purposes, utilization of hospital resources related to

separate and district E&M encounters performed in multiple outpatient hospital settings
on the same date may be reported by adding the modifier –27 to each appropriate level
outpatient and/or emergency department E/M code(s). This modifier provides a means
of reporting circumstances involving evaluation and management services provided by
physician(s) in more than one (multiple) outpatient hospital settings(s) .

-32 Mandated Services

Mandated services are those requested by an insurance carrier, peer review organization,
utilization review panel, HMO, PPO or other entity. Typically, the request is for a second
or third opinion regarding a patient's illness or treatment. When mandated services are
requested, the physician performing the service is usually required to accept assignment
from the payer, and in turn, the payer reimburses the doctor 100 percent of the payer's
allowable for the service.

An example of a mandated service would be an extended additional opinion

consultation. This would be reported as:

99274-32

The -32 modifier is used to alert the payer's claim processors that the service was
mandated and should receive special handling.
 Attachment A
MODIFIERS - CPT

-47 Anesthesia by Surgeon

When the surgeon is required to provide the general anesthesia services normally
handled by an anesthesiologist, the circumstance should be noted by adding the -47 or
09947 modifier to the surgery codes(s). This modifier is often used by surgeons working
in rural areas where the services of anesthesiologists or nurse anesthetists are not
always available. To report the modifier, list the surgery code(s) a second time, and place
the modifier on the second code.

For example, suppose the surgeon removed a ruptured appendix from a patient
and also provided a general anesthetic. The surgeon would code as follows:

44960 Appendectomy, ruptured appendix

44960-47 Anesthesia for appendectomy

Listing separate charges for each of the services would be appropriate.

-50 Bilateral Procedures

The bilateral modifier is restricted to surgical procedures only (CPT codes 10040 –
69990). It is not required for radiology procedure codes or diagnostic procedure codes.

Procedures are now assumed to be unilateral unless they are either always performed
bilaterally or are otherwise noted in CPT. The most commonly accepted method of
reporting bilateral procedures is to list the procedure twice and add the "-50" modifier to
the second procedure.

For example, Otoplasty is performed one a patient's left and right ears:

69300-RT Otoplasty, protruding ear RIGHT

69300-50-LT Otoplasty, protruding ear LEFT

Note that the words "right" and "left" have been added to clarify that the procedures
were indeed performed bilaterally. Also, it is common for physicians to report their full
charge for each procedure and let the payer reduce the amount on the second, or
bilateral, procedure.

Some payers accept an alternative method of billing bilateral procedures. This method
involves listing the procedure once and adding the "-50" modifier as shown below:

69300-50 Otoplasty, protruding ear, bilateral

If this method is used, place a "2" in the UNITS column of the claim form so that the
payer is aware that two procedures were performed. The charge reported on the claim
for the procedures is typically twice that of what the physician charges for performing
one of the procedures.
Bilateral procedures are identical procedures (i.e., you use the same CPT code)
performed on the same anatomic site but on opposite sides of the body. Furthermore, in
most instances, each procedure must be performed through its own separate incision to
qualify for bilateral.
 Note: Modifier –50 does not apply to radiology procedures.
Attachment A
MODIFIERS - CPT

-51 Multiple Procedures

This modifier has traditionally been used to identify multiple surgical procedures
performed on a patient during the same operative session. It is applicable when
unrelated procedures are performed during the same operative session or when multiple
related procedures are performed and there is no single inclusive code available. List the
major procedure or service (most revenue intensive) first on the HCFA-1500 claim form,
than attach modifier –51 to each applicable secondary procedure code.

For example, the repair of a simple neck wound and the closed treatment of a
clavicle fracture would be coded as:

23500 Treatment closed clavicle fracture without manipulation

12005-51 Simple closure neck wound

Note that the higher charge procedure (fracture treatment in this case) is listed
first and the multiple procedure modifier is added to the lesser or secondary
service. If three procedures had been performed, the services would be ranked
from highest to lowest charge on the claim form and the "-51" modifier would be
added to all but the first (highest charge) procedure.

-52 Reduced Service

Just as the unusual services modifier (-22) is used to denote abnormally difficult or time-
consuming procedures, the reduced service modifier -52 or 09952 signifies the opposite:
that a procedure was reduced or eliminated in part.

For example, consider the physician who removes a coccygeal pressure ulcer and
performs a coccygectomy but does not use a primary suture or skin flap closure.
(The physician wants to continue cleansing the wound for a period of time before
closing.) The proper way to report the procedure would be:

15920-52

At a later date the physician would code for the appropriate wound closure
procedure.

Many coders mistakenly use the "-52" modifier to reduce a charge for a patient who is
indigent. The physician performed the procedure or service as described, but did not
want to charge the patient the full amount. The "-52" modifier should NOT be used for
this purpose.

Effective January 1, 1999, a new modifier –73 replaces modifier –52 for
reporting discontinued services. Modifier –52 still applies to radiology
services for “reduced” but not terminated procedures.

Attachment A
MODIFIERS - CPT
-53 Discontinued Procedure

This modifier indicates that the physician elected to terminate a surgical or diagnostic
procedure. A surgical procedure may have been started, but because of extenuation or
threatening circumstances was discontinued. Modifier –53 is not used to report elective
cancellation of a procedure prior to the anesthesia induction and/or surgical preparation
in the operating suite.

Effective January 1, 1999, a new modifier –74 replaces modifier –53 for
reporting these discontinued services. Modifier –53 will not longer be an
acceptable modifier for hospital reporting to include radiology procedures.

-54 Surgical Care Only

When one physician performs a surgical procedure and another provides preoperative
and/or postoperative management, surgical services may be identified.

-55 Postoperative Management Only

When one physician performs the postoperative care and evaluation and another
physician performs the surgical procedure, the postoperative component may be
identified by adding the modifier ‘-55’ to the usual procedure number.

-56 Preoperative Management Only

When only one physician performs the preoperative care and evaluation and another
physician performs the surgical procedure, the preoperative component may be identified
by addition the modifier ‘-56’ to the usual procedure number.

-57 Decision for Surgery

Modifier –57 identifies an evaluation and management service that results in the initial
decision to perform surgery. Even though modifier –57 is included in the guidelines for
evaluation and management, surgery, and medicine services, it should only be reported
with E/M codes. It is to be used in circumstances where a major surgery is performed
within less than 24 hours of the initial evaluation.

Medicare has said that practices should use –57 only with major surgical procedures.
These are defined as procedures having a preoperative period one-day before the
surgery and 90 days afterward in the postoperative period. Many commercial carriers
have also adopted this ruling.

Example: A patient presents to the emergency department complaining of

acute lower abdominal pain. She is evaluated by a general
surgeon who determines that she has a ruptured appendix. He
immediately transfers her to the operating suite and performs an
appendectomy. The services would be coded as follows:

99284-57 Emergency room E/M service

44960 Appendectomy for ruptured appendix
Attachment A
 MODIFIERS - CPT

-58 Staged or Related Procedure or Service by the Same Physician during the
Postoperative Period

There are three ways to use modifier –58:

1. For a surgery result planned in stages – a staged procedure

Example: 54308-58 would be used for “urethroplasty for second stage

hypospadias repair; less than 3 cm” if this second stage was
performed during the postoperative period of the first procedure.

2. To report a more extensive procedure performed during the postoperative period

of a less extensive procedure.

Example: 54352-58 would be used for “repair of hypospadias cripple

requiring extensive dissection” if the procedure was performed
during the postoperative period of 54308 above.

3. To report a therapy given after a diagnostic surgical procedure

Example: 29870 “diagnostic knee arthroscopy”, carries a 90-day global

period. If a claim is reported under the same surgeon’s name
for physical therapy during the 90-day postoperative period,
97124-58 should be reported for the massage therapy.

-59 Distinct Procedural Service

Modifier –59 allows the physician to indicate that a procedure or service was distinct or
independent from other services performed on the same day. Modifier –59 is appropriate
for procedures or services that are not normally reported together, but are appropriate
under the circumstances. CPT states that modifier –59 may represent a different session
or patient encounter, different site or organ system, separate incision or excision,
separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily
encountered or performed on the same date by the same physician.

Example: On Monday, a dermatologist performs a biopsy on the face. On

Thursday, following the results of the biopsy, he removes the 2
cm malignant lesion and does another biopsy of a different site
on the face. The services performed on Thursday are reported
as follows:

11642 Excision malignant lesion, face

11100-59 Biopsy
 Attachment A
MODIFIERS - CPT

-60 Altered Surgical Field

Certain procedures involve significantly increased operative complexity and/or time in a

significantly altered surgical field resulting from the effects of prior surgery, marked
scarring, adhesions, inflammation, or distorted anatomy, irradiation, infection, and/or
trauma.

-62 Two Surgeons

This modifier has two distinct uses.

First, it is reported when two physicians are acting as co-surgeons. That is, each
surgeon is acting as a "primary" surgeon performing a different aspect of a
complex procedure.

Example: a laminectomy is performed jointly by a neurosurgeon

and an orthopedic surgeon. Each physician might list the
following on his/her claim:

63045-62 Laminectomy, cervical

Third party payers often allow sixty percent of their prevailing to each surgeon in
such cases.

Second, the two surgeons modifier may be used when two primary surgeons,
usually in different specialties, perform different procedures on a patient during
the same operative session.

Example: a general surgeon performs a windpipe incision on a trauma

patient while another surgeon works to stop the patient's
bleeding. Each surgeon could list his/her CPT code(s) with the
addition of the "-62" modifier thus denoting that the services
were performed during the same operative session.

Note that in the first example, each surgeon reported the same CPT code. Use of the two
surgeons modifier is important in such circumstances: it helps ensure that the payer understands
that two surgeons were involved in performing the procedure and that double billing is not taking
place. In the second example, each surgeon reported different CPT codes. Use of the two
surgeons modifier is not as important in this situation.

Due to increasing third party payment restrictions, it may be helpful to send a special report
(KISS letter) with the claim that explains and justifies the need for two Primary surgeons. Some
payers may assume that the procedure(s) can be performed by a primary surgeon and an
assistant rather than by two primary surgeons.
 Attachment A
MODIFIERS - CPT

-66 Surgical Team

Certain complex surgical procedures require the skills of more than two surgeons. A
good example is the surgical team that implants an artificial heart. As with the "62"
modifier, the physicians performing the surgery usually have different skills or specialties.
Each member of the team would add the -66 or 09966 modifier to the procedures he/she
performed as part of the surgical team.

As with the two surgeons situation, it may be necessary to communicate the need for the
team of surgeons to the insurance company. This is especially true in cases where the
need for the team may not be immediately obvious to the claims processor.

-73 Discontinued Out-Patient Hospital/Ambulatory Surgery Center Procedure

Prior to the Administration of Anesthesia

Due to extenuating circumstances or those that threaten the well being of the patient,
the physician may cancel a surgical or diagnostic procedure subsequent to the patient's
surgical preparation (including sedation when provided, and being taken to the room
where the procedure is to be performed), but prior to the administration of anesthesia
(local, regional block(s) or general). Under these circumstances, the intended service
that is prepared for but canceled can be reported by its usual CPT procedure code with
the addition of this modifier.

-74 Discontinued Out-Patient Hospital/Ambulatory Surgery Center Procedure

after Administration of Anesthesia

Due to extenuating circumstances or those that threaten the well being of the patient,
the physician may terminate a surgical or diagnostic procedure after the administration of
anesthesia or after the procedure was started (incision made, intubation started, scope
inserted, etc).

The elective cancellation of a service prior to the administration of anesthesia and/or

surgical preparation of the patient should not be reported. For physician reporting of a
discontinued procedure, see modifier -53.

-76 Repeat Procedure By Same Physician

-77 Repeat Procedure By Another Physician

These two modifiers are to be used when the procedure has been repeated subsequent
to the original service. You need to submit these modifiers because, without them, the
insurance company may think you accidentally double billed for the service.

Example: A patient is brought to the hospital with internal hemorrhaging

that is repaired surgically. Three days after surgery, the patient
begins hemorrhaging again and the surgeon must perform the
same repair again. Would you use the repeat procedure modifier
on the second repair? Yes, assuming that the same procedure
code was being reported. If a different physician had performed
the second repair, he/she would use the 77 modifier.
 Attachment A
MODIFIERS - CPT

It may be necessary to send a special report with the claim explaining why the procedure
needed
to be repeated. This is appropriate in cases where the need for the repeat may not be
clear to the carrier.

-78 Return to the Operating Room for a Related Procedure during the
Postoperative Period

Modifier –78 reports related procedures performed in the operating room within the
assigned postoperative period of a surgical. This modifier is often utilized when the
patient develops a complication that requires a return trip to the operating room for
intervention.

Example: A patient’s operative site bleeds after an initial surgery and

requires a return to the operating room to stop the bleeding, the
same procedure is not repeated. Thus a different code, 35860,
exploration for postoperative hemorrhage, thrombosis or
infection; extremity, would be reported with the -78 modifier
appended. Since the same procedure is not repeated, modifier –
76 would not be appropriate to use.

-79 Unrelated Procedure or Service by the Same Physician During the

Postoperative Period

Modifier –79 notifies payers that the procedure was performed during the postoperative
period of another procedure but is not related to that surgery. The diagnostic codes
must document medical necessity of the service, so the ICD-9-CM codes are usually
different for this service from those reported with the initial procedure.
Example: A patient has a femoral-popliteal graft (35556) and goes home.
The incision and graft heal well. However, the patient develops
acute renal failure a week after being home and is hospitalized.
The patient does not respond to medical treatment of the renal
failure. Hemodialysis is indicated, and a second physician inserts
a cannula for hemodialysis (36810).

The services of the second surgeon are reported as 36810-79

because this service is unrelated to the femoral-popliteal bypass
graft performed during the previous hospitalization.

If the –79 modifier is not appended to this procedure, the third-

party payer may not know that this service is not related to the
femoral-popliteal graft (i.e., the computer program used by the
third-party payer may not be able to distinguish that this service
is not related to the previous surgery and may automatically
reject this claim).

Providing documentation to indicate the service is unrelated to the first procedure may be helpful
compared to clearing up a problem retrospectively.

Attachment A
MODIFIERS - CPT

-80 Assistant Surgeon

One physician assists another physician in performing a procedure. If an assistant

surgeon assists a primary surgeon and is present for the entire operation, or a
substantial portion of the operation, then the assisting physician reports the same
surgical procedure as the operating surgeon. The operating surgeon does not append a
modifier to the procedure that he/she reports. The assistant surgeon reports the same
CPT code as the operation physician, with modifier –80 appended.

Example: To report a closure of intestinal cutaneous fistula, the primary

operating surgeon reports code 44640, and the assistant
surgeon reports 44640-80. The individual operative report
submitted by each surgeon should indicate the distinct service
provided by each surgeon.

-81 Minimum Assistant Surgeon

At times, while a primary operating physician may plan to perform a surgical procedure
alone, during an operation circumstances may arise that require the services of an
assistant surgeon for a relatively short time. In this instance, the second surgeon
provides minimal assistance, for which he/she reports the surgical procedure code with
the –81 modifier appended.

-82 Assistant Surgeon (Where Qualified Resident Not Available)

The prerequisite for using the –82 modifier is the unavailability of a qualified resident
surgeon. In certain programs (e.g., teaching hospitals), the physician acting as the
assistant surgeon is usually a qualified resident surgeon. However, there may be times
(e.g., during rotational changes) when a qualified resident surgeon is not available and
another surgeon assists in the operation. In these instances, report the services of the
nonresident-assistant surgeon with the –82 modifier appended to the appropriate code.
This indicates another surgeon is assisting the operating surgeon instead of a qualified
resident surgeon.

-90 Reference (Outside) Laboratory

When the physician bills the patient for lab work that was performed by an outside (or
"reference") lab, add the -90 or 09990 modifier to the lab procedure codes. Physicians
should never bill Medicare or Medicaid patients for lab work done outside their office.

Example: An internist performs an examination of a patient and, as part of

the exam, orders a complete blood count. He does not perform
in-office lab testing. He has an arrangement with a laboratory to
bill him for the testing procedure, and, in turn, he bills the
patient. The physician’s staff performs the venipuncture. The
physician reports the appropriate E/M code, the venipuncture
 (36415), and 85024-90 for the CBC performed by the outside
lab.

-91 Repeat Clinical Diagnostic Laboratory Test

May be appended to a laboratory test code to indicate that a laboratory test was
performed multiple times on the same day, for the same patient, and that it was
necessary to obtain multiple results in the course of treatment. Modifier –91 is not
intended to be used when laboratory tests are rerun to confirm initial results due to
testing problems encountered with specimens or equipment; or for any other reason
when a normal, one-time, reportable results is all that is required. Modifier –91 may not
be used when there are other code(s) to describe a series of test results (eg, glucose
tolerance tests, evocative/suppression testing).

-99 Multiple Modifiers

If two or more different modifiers are added to the same procedure, a third modifier, the
-99 or 09999 can be added to alert the carrier to the fact that two or more modifiers are
associated with the procedure.

For example, to report for the physician who assisted on a bilateral subcutaneous
mastectomy (19182) you would code as shown below. Since the procedure is bilateral,
you must list each procedure separately. In this case, each procedure will list the
assistant surgeon modifier (-82), and the second, bilateral procedure requires the use of
the -50 modifier. Since there are two modifiers on the second procedure, the -99
modifier is listed.

19182-82 (for the first procedure)

19182-99 (-99 for multiple modifiers on second procedure)

or

19182-50/82

Most carriers require that you have a charge for each line used on the claim form. Thus, you may
want to string the modifiers together on the same line on the claim form. You can do this by
putting the -99 modifier next to the code in the procedure column and listing the other modifiers
in the procedure description column.

Attachment B
 HCPCS MODIFIERS

Generally, HCPCS Modifier codes are required to add specificity to the reporting of procedures
performed on eyelids, fingers, toes, and arteries. They may be appended to CPT codes. If more
than one level II modifier applies, repeat the HCPCS code on to another line with the appropriate
level II modifier:

EXAMPLE: Code 26010 (drainage of finger abscess; simple) done on the left hand thumb
and second finger would be codes:
26010FA
26010F1

LT Left side (used to identify procedures on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
E1 Upper left, eyelid
E2 Lower left, eyelid
E3 Upper right, eyelid
E4 Lower left, eyelid
FA Left hand, thumb
F1 Left hand, second digit
F2 Left hand, third digit
F3 Left hand, fourth digit
F4 Left hand, fifth digit
F5 Right hand, thumb
F6 Right hand, second digit
F7 Right hand, third digit
F8 Right hand, fourth digit
F9 Right hand, fifth digit
TA Left foot, great toe
T1 Left foot, second digit
T2 Left foot, third digit
T3 Left foot, fourth digit
T4 Left foot, fifth digit
T5 Right foot, great toe
T6 Right foot, second digit
T7 Right foot, third digit
T8 Right foot, fourth digit
T9 Right foot, fifth digit
GC This service has been performed in part by a resident under the direction of a
teaching physician.
GE This service has been performed by a resident without the presence of a teaching
physician under the primary care exception
 Attachment B
HCPCS MODIFIERS

LD Left anterior descending coronary artery (LAD)

LC Left circumflex coronary artery
RC Right coronary artery (RCA)

QM Ambulance service provided under arrangement by provider of services

QN Ambulance service furnished directly by provider of services

Anesthesia
Modifiers
(Physical
Status)
P1-A A normal healthy patient.
P2-A A patient with mild systemic disease.
P3-A A patient with severe systemic disease.
P4-A A patient with severe systemic disease that is a constant threat to life.
P5-A A moribund patient who is not expected to survive without the operation.
P6-A A declared brain-dead patient whose organs are being removed for donor
purposes.
Note: P1-P6 will
be used when
VHA begins to
bill for unit-based
components for
anesthesia.

Other
AA Anesthesia services performed personally by anesthesiologist
AD Medically supervised by a physician for more than four concurrent
procedures
QK Medically directed by a physician: two, three, or four concurrent
procedures
QX CRNA with medical direction by a physician
QY Medical direction of one certified registered nurse anesthetist (CRNA) by
an anesthesiologist
QZ CRNA without medical direction by a physician
Monitored
Anesthesia
Care
QS Monitored anesthesia care service (MAC)
MAC involves the intraoperative monitoring of the patient’s vital
physiological signs in anticipation of the need for administration of general
anesthesia or of the development of adverse physiological patient reaction
to the surgical procedures.
G8 Monitored anesthesia care (MAC) for deep, complex, complicated, or
markedly invasive surgical procedure. (Applicable to CPT 00100, 00400,
00160, 00300, 00532, 00920)
Note: The G8 modifier should not be reported in conjunction with a “QS”
modifier, but it must be reported with the pertinent anesthesia payment
modifier for personally performed anesthesia or medical direction.
G9 Monitored anesthesia care (MAC) for patient who has history of severe
cardio-pulmonary condition. (Reference: HCFA Transmittal No. B-99-17
Date April 1999 and HCFA Transmittal No. B-99-38 Date November 1999)

Therapists
Modifiers
GN Speech language therapy
GO Occupational therapy
GP Physical therapy
 Attachment C

EVALUATION AND MANAGEMENT SERVICES TABLE