CSHCN 2009 >29.2.4.3 Anesthesia Modifiers

Each anesthesia procedure code must be submitted with the appropriate anesthesia modifier(s) whether billing as the sole provider or for the medical direction of CRNAs or other qualified professionals.

When an anesthesia service is billed without the appropriate reimbursement modifiers, or is billed with modifier combinations other than those listed in this article, the claim is denied.

A claim billed with a modifier indicating that the anesthesia was not medically directed or medically supervised (modifier AD, QK, QX, or QY) is denied if a previous claim has been billed with a modifier indicating the service was personally performed (modifier AA or QZ) and is reimbursed for the same client, date of service, and procedure code.

A claim billed with a modifier indicating that the anesthesia was personally performed by an anesthesiologist (modifier AA) is denied if another claim has been paid indicating the service was personally performed by, and reimbursed to, a CRNA (modifier QZ) for the same client, date of service, and procedure code. The opposite is also true-a CRNA-administered procedure is denied if a previous claim was paid to an anesthesiologist for the same client, date of service, and procedure code. Denied claims may be appealed with supporting documentation of any unusual circumstances.

Modifiers U1 (indicating one anesthesia claim is expected) and U2 (indicating two anesthesia claims are expected) are state-defined modifiers that may be billed by an anesthesiologist or CRNA. Modifier U3 indicates that the anesthesia was performed with dental services.

Modifier U1, indicating that only one claim will be submitted, cannot be billed by two providers for the same procedure, client, and date of service. Modifier U2, indicating that two claims will be submitted, can only be billed by two providers for the same procedure, client, and date of service if one of the providers was medically directed by the other. Denied claims may be appealed with supporting documentation of any unusual circumstances.

Anesthesia providers must submit the U1 or U2 modifier in combination with an appropriate pricing modifier when billing for anesthesia procedure codes.

Modifiers AA and U1 must both be submitted when an anesthesiologist has personally performed the anesthesia service.

Anesthesiologists may be reimbursed for medical direction of anesthesia practitioners by using one of the following modifier combinations:


Modifier Combination Submitted by Anesthesiologist	When is it used?	Who will submit claims?
Anesthesiologist Providing Medical Direction or Medical Supervision to Non-CRNA Qualified Professionals
QY and U1	When medically directing one procedure performed by a non-CRNA qualified professional.	Only the anesthesiologist
QK and U1	When medically directing two, three, or four concurrent procedures provided by non-CRNA qualified professionals.	Only the anesthesiologist
AD and U1 (emergency circumstances only)	When medically supervising five or more concurrent procedures provided by non-CRNA qualified professionals. The AD modifier must be used in emergency circumstances only and limited to 6 units (90 minutes) per case for each occurrence requiring five or more concurrent procedures.	Only the anesthesiologist
Anesthesiologist Providing Medical Direction or Medical Supervision of CRNAs
QY and U2	When medically directing one procedure provided by a CRNA.	Both the anesthesiologist and CRNA
QK and U2	When medically directing two, three, or four concurrent procedures involving CRNA(s).	Both the anesthesiologist and CRNA
AD and U2 (Emergency circumstances only)	When medically supervising five or more concurrent procedures involving CRNA(s). The AD modifier must be used in emergency circumstances only and limited to 6 units (90 minutes) per case for each occurrence requiring five or more concurrent procedures.	Both the anesthesiologist and CRNA

Modifiers QZ and U1 must be submitted when a CRNA has personally performed the anesthesia services, is not medically directed by the anesthesiologist, and is directed by the surgeon.

Modifiers QX and U2 must be submitted by a CRNA who provided services under the medical direction of an anesthesiologist.

Anesthesiologists or CRNAs may use modifier QS to report monitored anesthesia care.

The QS modifier is an informational modifier, and must be billed with any combination of pricing modifiers for reimbursement.