Summary of change: WellCare (Staywell) has updated their Anesthesia modifier policy to align with CMS Billing guidelines. CMS Medicare Claims Processing Manual (PDF, 1 MB) (Pub. 100-04), Chapter 12
Anesthesia services reimbursement are calculated in part based on modifiers submitted with Anesthesia services.
The chart below lists Modifiers that may only be submitted with anesthesia procedure codes (i.e., CPT codes 00100-01999). CPT codes 01995 or 01996 are not recognized for time units and should not be submitted with time units in the quantity billed field.
NOTE: For payment purposes, qualified non-physician anesthetists include both Certified Registered Nurse Anesthetists (CRNAs) and anesthesiologists' assistants (AAs). Physicians report the appropriate modifier to denote whether the service meets the requirements for payment at the personally performed rate, medically directed rate, or medically supervised rate.
Anesthesia 'Medical Direction' Modifiers
| HCPCS Modifier | Description |
|---|---|
| AA | Anesthesia services personally performed 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 | Qualified non-physician anesthetist services with medical direction by a physician |
| QY | Medical direction of one qualified non-physician anesthetist by an anesthesiologist |
| QZ | CRNA service without medical direction by physician |
Monitored Anesthesia Care Modifiers
| HCPCS Modifier | Description |
|---|---|
| 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 cardio-pulmonary condition |
| QS | Monitored anesthesia care service |
NOTE: The QS HCPCS modifier can be used by a physician or a qualified non-physician anesthetist and is for informational purposes. Providers must report actual anesthesia time and one of the payment modifiers on the claim.
NOTE: Submit the appropriate modifier to indicate 'monitored anesthesia care' in addition to the medical direction modifier. Submit only one monitored anesthesia care modifier per service. Submit the medical direction modifier first, followed by the monitored anesthesia care modifier, if appropriate.
Reference Source:
- CMS Medicare Claims Processing Manual (PDF, 1 MB) (Pub. 100-04), Chapter 12
- Definitions of personally performed, medically directed and medically supervised: Section 50
- Definition of concurrent procedures: Section 50.C
- Monitored Anesthesia Care 50.H
- Anesthesia claims modifiers: Section 50.I
- Billing Modifiers for qualified non-physician anesthetists: Section 140.3.3
