RetiredPremera BluecrossPolicy N/A

Anesthesia Modifiers

Defines when Premera recognizes anesthesia procedure modifiers on CMS-1500 or 837P claims, which modifiers are acceptable, how reimbursement is adjusted based on modifier, and an exception for one procedure code. Applies to Premera Blue Cross, Premera BCBS Alaska, LifeWise Health Plan of Washington, LifeWise Assurance Company and Premera HMO lines; excludes Medicare Advantage products.

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 modifier to each anesthesia service code (00100-01992, 01999) on CMS-1500 or 837P claims; claims without a modifier will be denied reimbursement.

SourceLink

POLICY UPDATE CHANGES

Effective November 24, 2024, procedure code 01996 does not require an anesthesia modifier.

Policy archived effective 2025-10-07; directs readers to Anesthesia Guidelines policy.

Added statement that services billed without a modifier will be denied reimbursement.

6Recognized Modifiers Listed

00100-01992,01999Anesthesia CPT Codes Covered (range)

01996Exception Code

Policy summary

This policy defines the required anesthesia provider modifiers for professional claims submitted on CMS-1500 or 837P forms, the reimbursement adjustments tied to specific modifiers (including reduced payment to 50% for certain supervised/directed services), an exception that procedure code 01996 does not require an anesthesia modifier effective November 24, 2024, and that services billed without a modifier will be denied reimbursement. The policy excludes Medicare Advantage products, applies to specified Premera lines, and is marked RETIRED/archived effective October 7, 2025.

Policy metadata

Effective Date

Last Review2025-10-07

Next Review

StatusRETIRED

SubjectAnesthesia Modifiers

Policy NumberN/A

Scope SummaryDefines when Premera recognizes anesthesia procedure modifiers on CMS-1500 or 837P claims, which modifiers are acceptable, how reimbursement is adjusted based on modifier, and an exception for one procedure code. Applies to Premera Blue Cross, Premera BCBS Alaska, LifeWise Health Plan of Washington, LifeWise Assurance Company and Premera HMO lines; excludes Medicare Advantage products.

Modifier requirement and scope

Modifier requirement and recognition

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/codes submitted without a modifier will be denied reimbursement. Medicare Advantage products are not subject to this policy.

ALL of the following

Modifier appended to anesthesia codes: Modifier must be appended to each anesthesia service code (codes 00100-01992, 01999) submitted on CMS-1500 or 837P claims.
Missing modifier denial: Anesthesia services/codes submitted without a modifier will be denied reimbursement.
Medicare Advantage exclusion: Medicare Advantage products are not subject to this policy.

Applies to 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; Medicare Advantage products are not subject to this policy.

Codes and recognized modifiers

Anesthesia codes requiring modifierCPTCovered

00100-01992	Anesthesia procedure codes range requiring a provider modifier
01999	Unlisted anesthesia procedure code requiring a provider modifier

Exception - anesthesia modifier not requiredCPT

01996

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

Recognized anesthesia modifiersHCPCS

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

Procedure codes not requiring an anesthesia modifier effective date specified:

ALL of the following

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

Billing, reimbursement adjustments, and documentation

Billing Rule

Append modifier to anesthesia claims

Append the appropriate HCPCS anesthesia modifier to each anesthesia service code (00100-01992, 01999) on CMS-1500 or 837P claims. Claims for these anesthesia services submitted without a modifier will be denied reimbursement.

Affected codes: 00100-01992, 01999
Claims without a modifier will be denied

Billing Rule

Use of specific modifiers adjusts reimbursement

When modifiers AD, QK, QX, or QY are appended, reimbursement for the supervising/directed physician or CRNA will be adjusted to 50% of the provider's applicable Fee Schedule allowed amount as specified. Modifiers AA and QZ are informational only and do not affect reimbursement.

AD, QK, QX, QY = reimbursement adjusted to 50%
AA, QZ = informational; reimbursement not affected

Billing Rule

Exception for 01996

Do not append an anesthesia modifier for CPT code 01996 on or after November 24, 2024.

Effective date: 2024-11-24

Documentation Required

Refer to Anesthesia Guidelines for increased service

Increased anesthesia service should be reported by billing additional time units or using physical status modifiers per the Anesthesia Guidelines rather than appending modifier 22.

See the Anesthesia Guidelines policy for details on billing increased anesthesia services

Modifier definitions and meanings

Definitions

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%).

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

QXCRNA service: with medical direction by a physician (CRNA reimbursement adjusted to 50%).

QYMedical direction of one CRNA by an anesthesiologist (physician reimbursement adjusted to 50%).

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

Reporting increased service and references

Increased anesthesia service reporting

Guidance on reporting increased anesthesia service time or effort:

ALL of the following

Bill additional time units: For increased anesthesia service, additional time units should be billed instead of modifier 22.
Use physical status modifiers: Alternatively, increased anesthesia service may be billed with physical status modifiers to identify that additional work was required to render the anesthesia service.
Refer to Anesthesia Guidelines: See Anesthesia Guidelines policy for additional information.

For procedural detail and examples (including guidance on reporting increased anesthesia service time, use of additional time units or physical status modifiers, and illustrative use of recognized modifiers), refer to the Anesthesia Guidelines policy as cross-referenced; note the policy was archived effective October 7, 2025 and exceptions (e.g., code 01996 effective 2024-11-24) are documented in this policy.

Policy changes and timeline

2024-11-24material_change_added

Effective November 24, 2024, procedure code 01996 does not require an anesthesia modifier.

2025-10-07archivedLatest

Policy archived effective October 7, 2025 and cross-referenced to the Anesthesia Guidelines policy.

2024-11-12clarification

Clarified that anesthesia services/codes submitted without a modifier will be denied reimbursement.

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 modifier to each anesthesia service code (00100-01992, 01999) on CMS-1500 or 837P claims; claims without a modifier will be denied reimbursement.

SourceLink

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