Medical Policy
Effective Date:11/01/2014 Title:Anesthesia Modifiers
Revision Date: Document:BI455:00
CPT Code(s):
Public Statement

Effective Date:

a)    This policy will apply to all services performed on or after the above revision date which will become the new effective date.

b)    For all services referred to in this policy that were performed before the revision date, contact customer service for the rules that would apply.

Modifiers to CPT codes for anesthesia are designed to indicate either the severity of the patient’s underlying condition or the level of training or supervision of the physician or CRNA providing the service.  This policy specifies how these modifiers will be processed by QualChoice.
Medical Statement

 

1)    QualChoice will not cover anesthesiologist supervision of more than four concurrent procedures.  Modifier AD will result in denial.

2)    QK and QY describe anesthesiologist supervision of a CRNA performing anesthesia services.  These modifiers pay at a reduced rate.

3)    QX describes CRNA services that are supervised by an anesthesiologist.  This modifier pays at a reduced rate.

4)    Modifiers AA, QS, QZ, G8, and G9 do not influence payment.

5)    Modifiers P1, P2, and P6 do not influence payment.  Modifier P3 adds one unit, modifier P4 adds two units, and modifier P5 adds three units.
Limits
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Reference
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Application to Products
This policy applies to all health plans administered by QualChoice, both those insured by QualChoice and those that are self-funded by the sponsoring employer, unless there is indication in this policy otherwise or a stated exclusion in your medical plan booklet. Consult the individual plan sponsor Summary Plan Description (SPD) for self-insured plans or the specific Evidence of Coverage (EOC) for those plans insured by QualChoice. In the event of a discrepancy between this policy and a self-insured customer’s SPD or the specific QualChoice EOC, the SPD or EOC, as applicable, will prevail. State and federal mandates will be followed as they apply.
Changes: QualChoice reserves the right to alter, amend, change or supplement benefit interpretations as needed.