CurrentPremera BluecrossPolicy N/A

Modifier 47 - Anesthesia by Surgeon

Defines when Premera recognizes CPT modifier 47 on professional claims to indicate regional or general anesthesia provided by the surgeon and related reimbursement and policy constraints; applies across Premera lines of business and products for professional (CMS-1500/837P) claims.

Policy Summary

PayerPremera Bluecross

PolicyModifier 47 - Anesthesia by Surgeon

Policy CodePolicy N/A

Change TypeClarified

Effective Date

Next Review Date

Key ActionProvider must append Modifier 47 only to the surgical procedure code when the surgeon also renders regional or general anesthesia; do not append for local anesthesia or moderate sedation.

SourceLink

POLICY UPDATE CHANGES

Revised to bullet out inappropriate uses of modifier 47 and clarified when it is appropriate to use modifier 47.

1Recognized Modifier

4Listed inappropriate uses/examples

0Additional anesthesia reimbursement when used

Policy Summary

This Premera policy defines recognition and reimbursement rules for CPT Modifier 47 when submitted on professional claims (CMS-1500/837P). It applies across Premera lines of business and products. When the policy criteria are met and Modifier 47 is appended to a surgical procedure code to indicate the surgeon provided regional or general anesthesia, the anesthesia component is considered included in the surgical service (no additional anesthesia reimbursement).

Policy TitleModifier 47 - Anesthesia by Surgeon

PayerPremera Bluecross

Policy NumberN/A

StatusCURRENT

Last Review Date2026-02-06

Effective DateN/A

Next Review DateN/A

Scope SummaryDefines when Premera recognizes CPT modifier 47 on professional claims to indicate regional or general anesthesia provided by the surgeon and related reimbursement and policy constraints; applies across Premera lines of business and products for professional (CMS-1500/837P) claims.

Recognition and Non‑Recognition Criteria

Recognition of Modifier 47

Modifier 47 is recognized when ALL of the following are met:

ALL of the following

Modifier 47 is appended to a surgical procedure code to indicate regional or general anesthesia was provided by the attending or assistant surgeon in addition to performing the surgical service.
The claim is a professional claim (CMS-1500 or 837P).
Policy clarified to apply to professional services billed on CMS-1500/837P.
The anesthesia provided is regional or general (not local anesthesia or moderate sedation).
The service is within the provider's scope of practice and subject to applicable fee schedule.
No additional reimbursement will be available for the anesthesia when Modifier 47 is appended; anesthesia is considered included.

Situations where Modifier 47 is NOT appropriate

Modifier 47 is not appropriate in ANY of the following situations:

ANY of the following

Appended to an anesthesiology code (CPT codes 00100-01999).
Used to represent a local anesthesia service.
Submitted by an Anesthesiologist on any anesthesia codes.
Appended to any surgical service code when the surgeon renders moderate sedation rather than regional or general anesthesia.

Codes and Coding Guidance

Anesthesiology code range referencedCPTNot Covered

00100-01999

Anesthesiology CPT code range — modifier 47 should not be appended to these codes

Modifier referencedModifier

47	Anesthesia by surgeon — recognized when appended to a surgical procedure code under policy criteria

Do not append Modifier 47 to anesthesiology CPT codes in the range 00100-01999 and do not submit Modifier 47 when an anesthesiologist provided the anesthesia. Modifier 47 is appended only to a surgical procedure code when the surgeon (attending or assistant) also renders regional or general anesthesia; it should not be used to report local anesthesia or moderate sedation.

Billing Rules, Documentation and Risk

Billing Rule

Append Modifier 47 only when surgeon provides general or regional anesthesia

Modifier 47 may be appended only to the surgical procedure code when the surgeon (attending or assistant) also provides regional or general anesthesia. This is recognized on professional claims and is limited by the provider's scope of practice and applicable fee schedule.

Billing Rule

Do not append Modifier 47 to anesthesiology codes

Modifier 47 must not be appended to anesthesiology CPT codes in the range 00100-01999, and should not be submitted when an anesthesiologist provided the anesthesia.

00100-01999

Billing Rule

No additional anesthesia reimbursement when Modifier 47 is used

When Modifier 47 is appended and the policy criteria are met (surgeon provided regional or general anesthesia on a professional claim and service is within scope/fee schedule), no additional reimbursement will be made for the anesthesia component; it is considered included in the surgical service.

Denial Risk

Potential audit and contractual penalties for violations

Violations of this policy may lead to increased auditing and monitoring, performance-guarantee contractual penalties and/or termination of contract; disciplinary actions will be determined by the plan.

Key Terms

Modifier 47CPT modifier indicating anesthesia by surgeon; used to indicate the surgeon provided regional or general anesthesia in addition to performing the surgical service.

Clarifying noteModifier 47 is appended only to the surgical procedure code when the surgeon performing the surgery also renders general or regional anesthesia; not appropriate for local anesthesia or moderate sedation.

RestrictionDo not append Modifier 47 to anesthesiology CPT codes 00100-01999 or when an anesthesiologist provided the anesthesia.

Reimbursement noteNo additional reimbursement will be available for the anesthesia when Modifier 47 is appended; anesthesia is considered included in the surgical service.

Document Version History

02/06/26clarifiedLatest

Annual review; no changes. Version history notes 'Annual review; no changes' on 02/06/26 and indicates prior clarifications bulleted inappropriate uses and clarified application to professional claims.

02/04/25clarified

Annual review; no changes.

03/04/24clarified

Annual review; no changes.

04/06/23clarified

Annual review; no changes.

05/12/22clarified

Clarified in the first paragraph that modifier 47 is appended to a surgical service code.

05/27/21clarified

Annual review; no changes.

06/15/20clarified

Clarified in the Purpose statement that the policy applies to professional services billed on a CMS-1500 or 837P claim form.

07/30/19clarified

Annual review; no changes.

10/18/18clarified

Revised the second paragraph of the Policy statement to bullet out the inappropriate uses of modifier 47 and clarified when it is appropriate to use modifier 47.

10/01/04clarified

Original effective date referenced; version history includes multiple subsequent annual reviews and clarifications.

Policy Summary

PayerPremera Bluecross

PolicyModifier 47 - Anesthesia by Surgeon

Policy CodePolicy N/A

Change TypeClarified

Effective Date

Next Review Date

Key ActionProvider must append Modifier 47 only to the surgical procedure code when the surgeon also renders regional or general anesthesia; do not append for local anesthesia or moderate sedation.

SourceLink

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