RetiredPremera BluecrossPolicy N/A

Anesthesia Modifiers

Defines when the Plan recognizes anesthesia procedure modifiers on CMS-1500/837P claims, applicable to Premera Blue Cross, Premera BCBS Alaska, LifeWise Health Plan of Washington, LifeWise Assurance Company and Premera Blue Cross HMO lines of business (excludes Medicare Advantage). Specifies required modifiers for anesthesia codes and reimbursement adjustments tied to those modifiers.

Policy Summary

PayerPremera Bluecross

PolicyAnesthesia Modifiers

Policy CodePolicy N/A

Change TypeArchive; Exception added; Clarification

Effective DateN/A

Next Review DateN/A

Key ActionProviders must append an appropriate HCPCS/anesthesia modifier to each anesthesia service code (00100-01992, 01999) on CMS-1500 or 837P claims; services submitted without a modifier will be denied reimbursement.

SourceLink

POLICY UPDATE CHANGES

Policy archived effective 10/07/25; refer to Anesthesia Guidelines policy

Exception added: procedure code 01996 does not require an anesthesia modifier effective 11/24/24

Added statement that services billed without a modifier will be denied reimbursement (02/18/19 addition)

6Recognized Modifiers Listed

00100-01992,01999Anesthesia Codes Covered

1Exception Codes (no modifier)

Policy summary and scope

This payment policy defines recognition and payment effects of anesthesia modifiers to identify the provider role (e.g., anesthesiologist, CRNA, supervision/medical direction) on professional claims. It applies to services billed on CMS-1500 and 837P forms for Premera Blue Cross, Premera Blue Cross Blue Shield of Alaska, LifeWise Health Plan of Washington, LifeWise Assurance Company and Premera Blue Cross HMO lines of business and products, and specifically excludes Medicare Advantage. The policy is RETIRED (archived effective 10/07/25); archived status and cross-references indicate users should refer to the Anesthesia Guidelines policy for current operational guidance.

Policy at a glance

PayerPremera Blue Cross; Premera BCBS Alaska; LifeWise Health Plan of Washington; LifeWise Assurance Company; Premera Blue Cross HMO

Policy TitleAnesthesia Modifiers

Policy NumberN/A

StatusRETIRED

Effective Date

Last Review2025-10-07

Next Review

Key ActionAppropriate anesthesia modifiers required on anesthesia service codes; services submitted without a modifier will be denied reimbursement

Coverage rule & criteria

General Requirement for Modifier on Anesthesia Services

An appropriate HCPCS modifier is required to be added to each anesthesia service code submitted in order to identify the level of the provider who rendered the service. Reimbursement may be adjusted based on modifier. Services submitted without a modifier will be denied reimbursement.

General requirement

Applies-to codes: Applies to anesthesia service codes 00100-01992, 01999
Billing requirement: An appropriate HCPCS modifier must be appended to each anesthesia service code submitted on CMS-1500 or 837P
Denial for missing modifier: Anesthesia services/codes submitted without a modifier will be denied reimbursement

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Exceptions

Procedure codes not requiring an anesthesia modifier effective date specified:

Exception - 01996: Effective November 24, 2024, procedure code 01996 (Daily hospital management of epidural or subarachnoid continuous administration drug) does not require an anesthesia modifier

Codes and modifiers

Anesthesia Procedure Codes Requiring ModifierCPTCovered

00100-01992	Range of anesthesia procedure codes; modifier required
01999	Unlisted anesthesia procedure; modifier required

Recognized Anesthesia ModifiersModifier

AA	Anesthesiology services performed personally by an anesthesiologist
AD	Medical supervision by a physician: more than four concurrent anesthesia procedures
QK	Medical direction of two, three or four concurrent anesthesia procedures
QX	CRNA service: with medical direction by a physician
QY	Medical direction of one CRNA by an anesthesiologist
QZ	CRNA service: without medical direction by a physician

Exception - No Modifier RequiredCPTNot Covered

01996

Daily hospital management of epidural or subarachnoid continuous administration drug (does not require an anesthesia modifier effective 2024-11-24)

Billing, documentation & payment impacts

Billing Rule

Append appropriate anesthesia modifier

An appropriate HCPCS/anesthesia modifier must be appended to each anesthesia service code (00100-01992, 01999) submitted on CMS-1500 or 837P claims. Services submitted without a modifier will be denied reimbursement.

00100-01992
01999

Billing Rule

Reimbursement adjustments for supervision/direction modifiers

When modifiers indicate physician medical supervision or medical direction (AD, QK, QX, QY), reimbursement will be adjusted to reflect 50% of the provider's applicable Fee Schedule allowed amount for the supervising/directed provider or CRNA as specified.

Documentation Required

Use of AA and QZ modifiers

Modifiers AA and QZ are informational and do not affect reimbursement, but must be used according to policy guidance (AA should not be used by an anesthesiologist when supervising or directing another anesthesiologist; QZ indicates a CRNA provided the service without physician supervision).

Billing Rule

Do not use Modifier 22 to indicate increased anesthesia time

Do not append Modifier 22 to indicate increased anesthesia work. For increased anesthesia service, bill additional time units or use physical status modifiers to identify the additional work. See the Anesthesia Guidelines policy for more information.

Modifier-specific payment adjustments

For situations involving increased anesthesia work, the policy directs that additional time units should be billed or physical status modifiers used to indicate the additional work required rather than appending Modifier 22; see the Anesthesia Guidelines policy for further details and examples.

Modifier definitions

Definitions - Recognized modifiers

AAAnesthesiology services performed personally by an anesthesiologist (informational; reimbursement not affected)

ADMedical supervision by a physician for more than four concurrent anesthesia procedures; physician reimbursement adjusted to 50% of applicable Fee Schedule amount

QKMedical direction of two, three or four concurrent anesthesia procedures; physician reimbursement adjusted to 50% of applicable Fee Schedule amount

QXCRNA service with medical direction by a physician; appended to CRNA/AA claims; CRNA reimbursement adjusted to 50% of applicable Fee Schedule amount

QYMedical direction of one CRNA by an anesthesiologist; appended to anesthesiologist's claim; physician reimbursement adjusted to 50% of applicable Fee Schedule amount

QZCRNA service without medical direction by a physician (informational; reimbursement not affected)

Document changes & timeline

11/24/24addition

Exception added: procedure code 01996 does not require an anesthesia modifier effective 11/24/24

02/18/19clarification

Added statement that services billed without a modifier will be denied reimbursement (02/18/19 addition)

10/07/25archiveLatest

Policy archived effective 10/07/25; refer to Anesthesia Guidelines policy

Policy Summary

PayerPremera Bluecross

PolicyAnesthesia Modifiers

Policy CodePolicy N/A

Change TypeArchive; Exception added; Clarification

Effective DateN/A

Next Review DateN/A

SourceLink

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