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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.2 Services, Benefits, Limitations, and Prior Authorization : 9.2.6 Anesthesia : 9.2.6.9 Anesthesia Modifiers

9.2.6.9
Each anesthesia procedure code must be submitted with the appropriate anesthesia modifier combination whether billing as the sole provider or for the medical direction of CRNAs, AAs, 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 below in the Modifier Combinations section, the claim will be denied.
A procedure billed with a modifier indicating that the anesthesia was personally performed by an anesthesiologist (modifier AA) will be 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 will be 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.
9.2.6.9.1
Modifiers U1 (indicating one Medicaid claim billed by an anesthesia practitioner and U2 (indicating two Medicaid claims) are state-defined modifiers that must be billed by an anesthesiologist, CRNA, or AA.
Modifier U1, indicating that only one Medicaid claim will be submitted, cannot be billed by two providers for the same procedure, client, and date of service. Modifier U2, indicating that two Medicaid 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 with an appropriate pricing modifier (AA, QY, QK, AD, QZ, QX) when billing for anesthesia procedure codes.
9.2.6.9.2
Modifiers AA and U1 must be submitted when an anesthesiologist has personally performed the anesthesia service.
Anesthesiologists may be reimbursed for medical direction of CRNAs, AAs, or other qualified professional by using one of the following modifier combinations:
 
Modifier Combination Submitted by Anesthesiologist
Anesthesiologist Directing Other Qualified Professionals
When directing one procedure provided by one other qualified professional.
Only the anesthesiologist
When directing two, three, or four concurrent procedures provided by other qualified professionals.
Only the anesthesiologist
AD and U1 (Emergency circumstances only)
When directing five or more concurrent procedures provided by other qualified professionals. 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
Both the anesthesiologist and CRNA, or AA
When directing two, three, or four concurrent procedures involving CRNA(s) or AA(s).
Both the anesthesiologist and CRNA or AA
When directing five or more concurrent procedures involving CRNA(s) or AAs. 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 or AA
9.2.6.9.3
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 or AA who provided services under the medical direction of an anesthesiologist.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.