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SHPBN-2016-057 Anesthesia Modifiers

Date: 08/04/16

Anesthesia Modifiers Billing Requirements

Effective with claims processed on and after August 1, 2016 (for MCOs, retroactive to January 1, 2013), medical direction/supervision of qualified individuals performing anesthesia procedures will be non-covered. This includes medical direction/supervision by a physician or anesthesiologist of a CRNA or anesthesiologist performing anesthesia procedures.

Anesthesia modifiers are required for procedure codes 00100 through 01999. One of the following modifiers must be reported with anesthesia services in the first modifier field to indicate who performed the anesthesia service. Anesthesia services billed without one of these modifiers will be denied:

  • AA – Anesthesia services performed personally by anesthesiologist
  • AD – Medical supervision by a physician: more than four concurrent anesthesia procedures
  • QK – Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals
  • QX – CRNA service; with medical direction by a physician
  • QY – Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist
  • QZ – CRNA service; without medical direction by a physician

The following modifiers can be reported in the second position under appropriate circumstances in addition to one of the previous anesthesia modifiers.

  • G8 – Monitored anesthesia care (MAC) for deep complex, complicated, or markedly invasive surgical procedure
  • G9 – Monitored anesthesia care for patient who has history of severe cardiopulmonary condition
  • QS – Monitored anesthesia care service
  • 23 – Unusual anesthesia

The following modifiers will be denied as non-covered:

  • QK – Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals
  • AD – Medical supervision by a physician, more than 4 concurrent anesthesia procedures
  • QY – Medical direction of one CRNA by an anesthesiologist (this has been non-covered since

The following anesthesia procedures do not require a modifier:

  • 01990 – Physiological support for harvesting of organ(s) from brain-dead patient
  • 01996 – Daily hospital management of epidural or subarachnoid continuous drug administration

Claims Billed Incorrectly

Claims billed for anesthesia services without the appropriate modifier(s) will be denied and must be corrected.  Instructions for the submission of Corrected Claims can be located in the Sunflower Provider Office Manual under the section titled "Billing and Claims Submission."

If you have questions about this bulletin or other provider resources, please contact our Customer Service Center at 1-877-644-4623.