Modifier -47 (“Anesthesia by Surgeon”) is appended to a surgical or procedural CPT code when the surgeon personally provides regional or general anesthesia for the procedure. Use of -47 indicates the surgeon administered the anesthesia (not merely monitored it) and does not apply to local anesthesia or to anesthesia administered by an anesthesiologist, CRNA, resident, or other non‑surgeon. The modifier must not be appended to anesthesia CPT codes (00100–01999); it is only reported on the surgical/procedure code to flag the surgeon’s anesthesia role.

In billing impact, modifier -47 is informational only: Medicare and common payer guidance treat anesthesia performed by the surgeon as included in the surgical fee and do not allow separate reimbursement for that anesthesia component. When the surgeon performs a separate nerve block or regional injection that has a distinct CPT code (for example, a femoral nerve block), that code may still be reported in addition to the surgical code with -47. Similarly, conscious or moderate sedation has separate reporting rules and codes and is not automatically paid separately simply because the surgeon provided the sedation.

Documentation should clearly support that the surgeon personally administered regional or general anesthesia rather than merely monitored it and should distinguish between local anesthesia, moderate sedation, and reportable regional/general anesthesia. Examples from payer guidance include reporting a bunionectomy with a surgeon‑performed femoral nerve block as 28296-47 plus the appropriate nerve block code (e.g., 64447), and reporting a complex incision and drainage where the surgeon provided conscious sedation as 10180-47 plus the conscious sedation code (e.g., 99141) and any drug J‑codes. Remember that -47 does not change that the anesthesia service is generally considered inclusive with the surgical payment under Medicare and similar payer policies.