RetiredPremera BluecrossPolicy N/A

Anesthesia Modifiers

Defines when Premera recognizes anesthesia procedure codes submitted with HCPCS/CPT modifiers on CMS-1500 or 837P claims, which modifiers are accepted, and how reimbursement is adjusted based on those modifiers. Applies to Premera Blue Cross, Premera BCBS of Alaska, LifeWise WA, LifeWise Assurance Co., and Premera HMO products (Medicare Advantage excluded).

Policy Summary

PayerPremera Bluecross

PolicyAnesthesia Modifiers

Policy CodePolicy N/A

Change TypeArchived; exceptions and clarifications added

Effective DateN/A

Next Review DateN/A

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

SourceLink

POLICY UPDATE CHANGES

Exception added to policy.

Document indicates this policy is archived and refers readers to Anesthesia Guidelines policy.

Operational clarification applied to claims handling.

Guidance to use time units or physical status modifiers instead of modifier 22 for increased anesthesia services.

6Recognized Modifiers

00100-01992, 01999Anesthesia Codes Requiring Modifier

01996Exception Code (no modifier required)

Policy summary

This policy defines which anesthesia HCPCS/CPT modifiers the Plan recognizes on professional claims and how reimbursement is adjusted when services are provided under supervision or direction of CRNAs and other qualified individuals; an appropriate anesthesia modifier is required to be appended to each anesthesia service code (codes 00100-01992, 01999) submitted on CMS‑1500 or 837P claims and services billed without a modifier will be denied reimbursement. It cross‑references the Anesthesia Guidelines and Modifier 22 guidance, clarifies that increased anesthesia work should be reflected by additional time units or physical status modifiers rather than modifier 22, and restricts reimbursement to the provider’s scope of practice and the applicable fee schedule. The policy applies to Premera Blue Cross, Premera BCBS of Alaska, LifeWise Health Plan of Washington, LifeWise Assurance Company and Premera HMO products (Medicare Advantage products are excluded). Note: effective November 24, 2024, procedure code 01996 does not require an anesthesia modifier, and the policy is archived effective October 7, 2025.

Policy metadata

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

PolicyAnesthesia Modifiers

Policy NumberN/A

StatusRETIRED

Effective Date

Last Review2025-10-07

Next Review

Key ActionAppend appropriate anesthesia modifier to each anesthesia service; services billed without a modifier will be denied reimbursement.

Modifier requirement and recognition

General recognition and requirement

An appropriate HCPCS modifier is required to be added to each anesthesia service code submitted to identify the provider who rendered the service. Anesthesia services submitted without a modifier will be denied reimbursement.

An appropriate HCPCS modifier must be appended to each anesthesia service code (codes 00100-01992, 01999).

Claims without an anesthesia modifier will be denied reimbursement.

If increased anesthesia service occurred, additional time units should be billed instead of modifier 22; or billed with physical status modifiers to identify additional work.

See Anesthesia Guidelines policy for more information.

Modifiers recognized and reimbursement effects

The Plan recognizes the following modifiers when appended to an anesthesia service to identify the provider who rendered the service. Reimbursement adjustments described below apply when the modifier is used.

Modifier rules

Codes and modifiers

Anesthesia procedure codes requiring modifierCPT

00100-01992	Range of anesthesia procedure codes to which modifiers must be appended
01999	Anesthesia procedure code included in modifier requirement

Procedure code excepted from modifier requirementCPT

01996

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

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

Billing, documentation, and payment impacts

Denial Risk

Append anesthesia modifier to each anesthesia service

Providers must append an appropriate HCPCS modifier to each anesthesia service code submitted on CMS-1500 or 837P claims. Applicable anesthesia procedure codes: 00100-01992 and 01999. Services billed without an anesthesia modifier will be denied reimbursement.

Affected codes: 00100-01992, 01999
Denial policy note: Anesthesia services/codes submitted without a modifier will be denied reimbursement

Billing Rule

Reimbursement adjustment for supervision/direction modifiers

When modifiers AD, QK, QX, or QY are used to indicate supervision or direction of CRNAs or other qualified individuals, reimbursement will be adjusted to reflect 50% of the provider's applicable Fee Schedule allowed amount associated with that modifier.

Key terms and modifier definitions

Definitions (recognized modifiers)

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

ADMedical supervision by a physician: more than four concurrent anesthesia procedures (physician reimbursement adjusted to 50% of applicable Fee Schedule allowed amount).

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

QXCRNA service: with medical direction by a physician (appended to CRNA/Anesthetist Assistant claims; CRNA reimbursement adjusted to 50% of applicable Fee Schedule allowed amount).

QYMedical direction of one CRNA by an anesthesiologist (physician reimbursement adjusted to 50% of applicable Fee Schedule allowed amount).

Policy changes and timeline

02/18/19material

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

10/13/22non-material

Added cross-reference to Modifier 22 and clarified that modifier 22 is not appropriate to indicate increased anesthesia services (10/13/22).

2024-11-24material

Identified that effective November 24, 2024, procedure code 01996 does not require an anesthesia modifier. Exception added to policy.

Policy Summary

PayerPremera Bluecross

PolicyAnesthesia Modifiers

Policy CodePolicy N/A

Change TypeArchived; exceptions and clarifications added

Effective DateN/A

Next Review DateN/A

SourceLink

On This Page

AA - Anesthesiology services performed personally by an anesthesiologist.

Informational only; reimbursement not affected. Should not be used by an anesthesiologist when supervision or direction is provided to another anesthesiologist. Use when provider acts as anesthesiologist while performing a surgical procedure in same operative session.

AD - Medical supervision by a physician: more than four concurrent anesthesia procedures.

Used by physician supervising four or more concurrent procedures; physician reimbursement will be adjusted to 50% of the provider's applicable Fee Schedule allowed amount.

QK - Medical direction of two, three or four concurrent anesthesia procedures.

Used when qualified individuals (e.g., CRNA) perform anesthesia services and physician supervises 2-4 concurrently; physician reimbursement will be adjusted to 50% of allowed amount.

QX - CRNA service: with medical direction by a physician.

Appended to CRNA or Anesthetist Assistant (AA) claims to indicate service provided under direction by an anesthesiologist; CRNA reimbursement adjusted to 50% of provider's applicable Fee Schedule allowed amount.

QY - Medical direction of one CRNA by an anesthesiologist.

Appended to the anesthesiologist's claim to indicate supervision of one CRNA; physician reimbursement adjusted to 50% of allowed amount.

QZ - CRNA service: without medical direction by a physician.

Informational only; reimbursement not affected.

Exception

Specific exception effective date

Procedure code 01996 - Daily hospital management of epidural or subarachnoid continuous drug administration does not require an anesthesia modifier.

Effective November 24, 2024.

Note

Informational modifiers do not affect payment

Modifiers AA and QZ are informational only and do not change reimbursement.

Billing Rule

Increased anesthesia service billing

For increased anesthesia services, bill additional time units rather than using modifier 22; alternatively, use physical status modifiers per the Anesthesia Guidelines.

See cross-reference: Modifier 22 guidance / Anesthesia Guidelines

CRNA service: without medical direction by a physician (informational; reimbursement not affected).

2025-10-07materialLatest

Policy archived effective October 7, 2025. Document indicates this policy is archived and refers readers to Anesthesia Guidelines policy.