CurrentPremera BluecrossPolicy N/A

Modifier 47 - Anesthesia by Surgeon

Defines when the plan recognizes CPT modifier 47 (Anesthesia by Surgeon) on professional claims and describes inappropriate uses, billing scope, and consequences for violations. Applies across Premera Blue Cross and affiliated lines of business for professional (CMS-1500 / 837P) claims.

Policy Summary

PayerPremera Bluecross

PolicyModifier 47 - Anesthesia by Surgeon

Policy CodePolicy N/A

Change TypeAnnual review; clarifications (non-material)

Effective DateN/A

Next Review DateN/A

Key ActionAppend modifier 47 only to the surgical procedure code when the surgeon also provides general or regional anesthesia and document that anesthesia type and provider.

SourceLink

POLICY UPDATE CHANGES

No material clinical/coverage changes identified; policy underwent routine annual review.

1Primary Billing Rule

4Explicit Exclusions

0Anesthesia Reimbursement

2026-02-06Last Annual Review

Policy summary

Purpose: Modifier 47 indicates the surgeon provided general or regional anesthesia in addition to performing the surgical service. Scope: The policy defines when the plan recognizes Modifier 47 on professional claims and applies to professional (CMS-1500 / 837P) claims across the listed Premera affiliates. Status: CURRENT. Last review: 2026-02-06. Misuse or inappropriate application (for example appending Modifier 47 to anesthesiology codes, for local anesthesia, or when moderate sedation was provided) may result in claim denials, increased auditing and monitoring, contractual penalties and/or termination of contract.

Policy TitleModifier 47 - Anesthesia by Surgeon

PayerPremera Bluecross

Policy NumberN/A

Effective Date

Last Review2026-02-06

Next Review

Scope SummaryDefines when the plan recognizes CPT modifier 47 (Anesthesia by Surgeon) on professional claims and describes inappropriate uses, billing scope, and consequences for violations. Applies across Premera Blue Cross and affiliated lines of business for professional (CMS-1500 / 837P) claims.

When Modifier 47 is recognized / Exclusions

When Modifier 47 is recognized

The Plan recognizes Modifier 47 when ALL of the following are met:

ALL of the following

Modifier 47 is appended to a surgical service code to indicate regional or general anesthesia was provided by the attending or assistant surgeon in addition to performing the surgical service.
The service is billed on a professional claim (CMS-1500 or 837P).
Policy clarified in 06/15/20 that it applies to professional services billed on CMS-1500/837P.
Anesthesia provided is regional or general (not local or moderate sedation).

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.

Relevant codes and explicit exclusions

Anesthesiology codes excluded for Modifier 47CPTNot Covered

00100-01999

Anesthesiology CPT code range — modifier 47 is not appropriate when appended to these codes.

Modifier 47 must be appended to the surgical procedure code (not to anesthesia CPT codes) to indicate the operating or assistant surgeon provided regional or general anesthesia; it is recognized only on professional claim forms (CMS-1500 or 837P).

Billing, documentation, and enforcement actions

Billing Rule

Append modifier 47 only to surgical procedure code

Modifier 47 must be appended only to the surgical procedure code when the surgeon performing the surgery also renders general or regional anesthesia; no additional reimbursement is available for the anesthesia.

Documentation Required

Document anesthesia type and provider

Provider must document that general or regional anesthesia (not local or moderate sedation) was provided by the operating/assistant surgeon when appending modifier 47.

Denial Risk

Claims denial or contract action for violations

Violations of this policy by any party that enters into a written arrangement with the Plan may result in increased auditing and monitoring, performance guarantee contractual penalties and/or termination of the contract; disciplinary actions will be determined by the plan.

Policy changes and review timeline

10/18/18revised

Revised the policy statement to bullet out inappropriate uses of modifier 47 and clarified when appropriate to use modifier 47.

06/15/20clarified

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

05/12/22clarified

Clarified that modifier 47 is appended to a surgical service code.

02/06/26annual_reviewLatest

Annual review; no changes.

Policy Summary

PayerPremera Bluecross

PolicyModifier 47 - Anesthesia by Surgeon

Policy CodePolicy N/A

Change TypeAnnual review; clarifications (non-material)

Effective DateN/A

Next Review DateN/A

Key ActionAppend modifier 47 only to the surgical procedure code when the surgeon also provides general or regional anesthesia and document that anesthesia type and provider.

SourceLink

On This Page

OpenPayer

Modifier 47 - Anesthesia by Surgeon

Policy summary

When Modifier 47 is recognized / Exclusions

Relevant codes and explicit exclusions

Billing, documentation, and enforcement actions

Key terms

Policy changes and review timeline