CurrentPremera BluecrossPolicy N/A

Modifier 47 – Anesthesia by Surgeon

Defines when the Plan recognizes CPT modifier 47 (Anesthesia by Surgeon) on professional claims across Premera Blue Cross lines of business and affiliated entities, and details inappropriate uses and reimbursement implications.

Policy Summary

PayerPremera Bluecross

PolicyModifier 47 – Anesthesia by Surgeon

Policy CodePolicy N/A

Change TypeRevision & clarifications; annual reviews

Effective DateN/A

Next Review DateN/A

Key ActionAppend Modifier 47 only to the surgical procedure code when the surgeon performing the surgery also renders general or regional anesthesia; do not append to anesthesiology codes or for local anesthesia or moderate sedation.

SourceLink

POLICY UPDATE CHANGES

Revised second paragraph to bullet out inappropriate uses of modifier 47 and clarified appropriate use.

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

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

Annual review with no changes.

1Primary Billing Modifier Addressed

4Listed Inappropriate Uses

Policy summary

Modifier 47 indicates anesthesia provided by the surgeon when appended to a surgical service to show the attending or assistant surgeon also provided regional or general anesthesia in addition to performing the surgical procedure. This policy defines recognition of Modifier 47 on professional claims and applies across Premera Blue Cross lines of business and affiliated entities for services submitted on a CMS-1500 or 837P claim form.

Coverage and payment when Modifier 47 is used are subject to member eligibility, applicable benefit limits, the Plan's medical policy and claims adjudication edits, and are restricted by the provider's scope of practice and the applicable fee schedule. No additional reimbursement will be provided for anesthesia when Modifier 47 is appended; inappropriate uses (for example appending to anesthesiology codes 00100-01999, for local anesthesia, by an anesthesiologist on anesthesia codes, or when only moderate sedation is rendered) are detailed in the policy.

When Modifier 47 is recognized and when it is not

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.
Submitted on a professional claim (CMS-1500 or 837P).
Policy clarified 06/15/20 that it applies to professional services billed on CMS-1500 or 837P.
Reimbursement is restricted to the provider's scope of practice and applicable fee schedule; no additional reimbursement will be available for the anesthesia as it is considered part of the surgical service.

Situations where Modifier 47 is NOT appropriate

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

ONE of

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.

Billing, documentation, and compliance actions

Billing Rule

Append modifier 47 only to surgical procedure code

Append Modifier 47 only to the surgical procedure code when the surgeon performing the surgery also renders general or regional anesthesia. Do not append Modifier 47 to anesthesiology codes or to services that are local anesthesia or moderate sedation.

00100-01999 (Anesthesiology CPT range) — do not append.

Documentation Required

Reimbursement and scope of practice

Ensure services appended with Modifier 47 are within the provider's scope of practice and supported by documentation. Modifier 47 indicates anesthesia provided by the surgeon and no additional reimbursement will be provided for the anesthesia when Modifier 47 is used because the anesthesia is considered part of the surgical service.

Denial Risk

Policy violations may trigger actions

Violations of this policy 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

10/18/2018material

Revised second paragraph to bullet out inappropriate uses of modifier 47 and clarified appropriate use.

06/15/2020clarification

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

05/12/2022clarification

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

03/04/2024annual_review

Annual review with no changes.

02/04/2025annual_review

Annual review with no changes.

02/06/2026annual_reviewLatest

Annual review with no changes.

Policy Summary

PayerPremera Bluecross

PolicyModifier 47 – Anesthesia by Surgeon

Policy CodePolicy N/A

Change TypeRevision & clarifications; annual reviews

Effective DateN/A

Next Review DateN/A

SourceLink

On This Page

OpenPayer

Modifier 47 – Anesthesia by Surgeon

Policy summary

When Modifier 47 is recognized and when it is not

Relevant code groups

Billing, documentation, and compliance actions

Key terms

Policy changes and review timeline