ModifiedPremera BluecrossPolicy CP.PP.245.v3.1

Modifier 73 – Discontinued ASC Procedure Prior to Administration of Anesthesia

Defines when Premera recognizes and reimburses facility billing for discontinued outpatient hospital or ambulatory surgery center (ASC) procedures using Modifier 73 (prior to administration of anesthesia) and Modifier 74 (after administration of anesthesia), including documentation, exclusions, and reimbursement adjustments. Applies to Premera Blue Cross, Premera BCBS of Alaska, LifeWise plans.

Policy Summary

PayerPremera Bluecross

PolicyModifier 73 – Discontinued ASC Procedure Prior to Administration of Anesthesia

Policy CodePolicy CP.PP.245.v3.1

Change TypeRevised / Clarified / Added

Effective Date

Next Review Date

Key ActionDocument why and when the physician decided to cancel the procedure, services and supplies rendered/not rendered, and time spent preoperatively (and operatively/post-operatively for Modifier 74).

SourceLink

POLICY UPDATE CHANGES

Policy name changed to include both Modifier 73 & 74 and modifier 74 details were added from archived modifier 74 policy effective March 5, 2026.

Clarified applicable kinds of anesthesia and documentation requirements for use of modifiers.

Added prohibition that modifier cannot be used if patient elects to discontinue procedure.

Multiple annual reviews with some marked 'no changes'.

2Modifiers addressed

50%Reimbursement level for Modifier 73

Reimbursement adjustment for Modifier 74

Policy summary & scope

Background: This policy defines Premera facility billing rules for discontinued outpatient hospital and ambulatory surgery center (ASC) procedures using Modifier 73 (discontinued prior to administration of anesthesia) and Modifier 74 (discontinued after administration of anesthesia). It aligns with AMA CPT and CMS guidance and specifies documentation, exclusions, and reimbursement adjustments.

Scope: Applies to Premera Blue Cross, Premera Blue Cross Blue Shield of Alaska, LifeWise plans (LifeWise Health Plan of Washington and LifeWise Assurance Company) and Premera Blue Cross for facility outpatient/ASC claims. The policy cross-references Modifier 52 (Reduced Services) and Modifier 53 (professional discontinued procedure) for appropriate situations and billing pathways.

Policy NumberCP.PP.245.v3.1

SubjectModifiers 73 & 74 - Discontinued Outpatient/ASC Procedures

StatusMODIFIED

Last Review02/06/26

Effective Date

Next Review

ScopeDefines when Premera recognizes and reimburses facility billing for discontinued outpatient hospital or ambulatory surgery center (ASC) procedures using Modifier 73 (prior to administration of anesthesia) and Modifier 74 (after administration of anesthesia); includes documentation, exclusions, and reimbursement adjustments. Applies to Premera Blue Cross, Premera BCBS of Alaska, LifeWise plans.

Recognition criteria for discontinued procedure modifiers (facility billing)

Modifier 73 - Discontinued Prior to Administration of Anesthesia (Facility Claims)

Modifier 73 is recognized when ALL of the following are met:

ALL of the following

Procedure requires anesthesia at an outpatient hospital or ambulatory surgical center (ASC).
Procedure was discontinued prior to the administration of anesthesia and before the surgical procedure was started (patient must have already been wheeled into the surgical suite).
Modifier 73 appended to the intended surgical procedure code representing the discontinued ASC or outpatient facility service.
Medical record documentation lists why and when the physician decided to cancel the procedure, services and supplies that were/were not rendered, and the time spent preoperatively.

Modifiers referenced & coding guidance

Modifiers referencedModifier

73	Discontinued Outpatient Hospital/ASC Procedure Prior to Administration of Anesthesia (facility only)
74	Discontinued Outpatient Hospital/ASC Procedure After Administration of Anesthesia (facility only)
52	Reduced Services (facility outpatient billing for services that do not require anesthesia)
53	Discontinued Procedure (professional services) - cross-reference; not appropriate for facility ASC/outpatient discontinued procedures

Modifier 73 and Modifier 74 are facility-only modifiers for discontinued ASC/outpatient procedures, distinguished by timing relative to anesthesia and/or procedure start: 73 is used when the procedure was discontinued prior to administration of anesthesia, 74 when discontinued after administration of anesthesia or after the procedure was started.

For services that do not require anesthesia (for example, radiology), facilities may append Modifier 52 (Reduced Services) for outpatient facility billing only. Modifier 53 is a professional-only discontinued procedure modifier and should not be appended to any discontinued ASC or outpatient facility service; professional claims should follow the Modifier 53 guidance.

Required documentation, billing rules, and payer actions

Documentation Required

Medical record documentation required for Modifiers 73/74

Document why and when the physician decided to cancel the procedure, services and supplies rendered/not rendered, and time spent preoperatively (and operatively/post-operatively for Modifier 74).

Billing Rule

Appropriate use and prohibition list

Do not append Modifiers 73 or 74 to unlisted procedure codes, add-on codes, professional service claims, or elective cancellations; append to facility procedure codes only as defined by timing relative to anesthesia/procedure start.

Unlisted procedure codes are billed
Add-on procedure codes are billed
Professional services (Modifier 73/74 are facility-only)

Key definitions

termAnesthesia (per policy)

definitionIncludes local, regional block(s), moderate sedation/analgesia ('conscious sedation'), deep sedation/analgesia, and general anesthesia.

notePer policy, anesthesia includes local, regional, moderate/deep sedation, and general anesthesia and is the applicable context for Modifiers 73 and 74.

Frequently asked questions

Q: When should I bill Modifier 73 vs Modifier 74? A: Use 73 when the procedure requiring anesthesia was discontinued before anesthesia was administered (patient already in the surgical suite). Use 74 when the procedure was discontinued after anesthesia was given or after the procedure was started (e.g., incision made, intubation started).

Q: Can I use Modifier 52 or 53 instead? A: For discontinued services that do not require anesthesia (eg, radiology), append Modifier 52 for outpatient facility billing only. Modifier 53 is for professional services and should not be appended to facility ASC/outpatient discontinued procedure claims.

Q: Are elective cancellations billable with these modifiers? A: No. Do not append Modifiers 73 or 74 for procedures electively discontinued by the patient or physician; electively cancelled procedures are explicitly excluded.

Q: What documentation is required? A: Medical records must document why and when the physician decided to cancel the procedure, which services and supplies were or were not rendered, and time spent preoperatively (and operatively/post-operatively for Modifier 74).

Q: How are these claims reimbursed? A: Services appended with Modifier 73 are adjusted to 50% of the applicable Fee Schedule; services with Modifier 74 receive no reimbursement adjustment.

Policy changes & timeline

2026-03-05material_change

Policy name changed to include both Modifier 73 & 74 and modifier 74 details were added from archived modifier 74 policy effective March 5, 2026; modifier 52 details for non-anesthesia discontinued services (e.g., radiology) were also added and 'electively cancelled procedures' were added to exclusions.

2024-04-08clarification

Expanded documentation requirements and clarified correct/incorrect use of Modifier 73; added new paragraph on correct use of Modifier 74 and clarified applicable kinds of anesthesia and required medical record rationale for discontinuation.

2020-08-17added_prohibition

Policy Summary

PayerPremera Bluecross

PolicyModifier 73 – Discontinued ASC Procedure Prior to Administration of Anesthesia

Policy CodePolicy CP.PP.245.v3.1

Change TypeRevised / Clarified / Added

Effective Date

Next Review Date

SourceLink

On This Page

Modifier 73 must NOT be appended when ANY of the following apply:

Procedure was electively discontinued by the patient or physician.
Unlisted procedure codes are billed.
Electively cancelled procedures.
Add-on procedure codes are billed.
Professional services (Modifier 73 is facility-only).
Procedure was discontinued after the administration of anesthesia.

Reimbursement: Claims with Modifier 73 will be reimbursed at 50% of the applicable Fee Schedule allowed amount.50%

Modifier 74 - Discontinued After Administration of Anesthesia (Facility Claims)

Modifier 74 is recognized when ALL of the following are met:

ALL of the following

Procedure requires anesthesia at an outpatient hospital or ASC and was discontinued after the administration of anesthesia or after the procedure was started (incision made, intubation started, etc.).
Modifier 74 appended to the ASC or outpatient facility surgical procedure code that was discontinued after administration of anesthesia or start of the procedure.
Medical record documentation indicates why and when the physician decided to cancel the procedure, services and supplies that were/were not rendered, and time spent preoperatively, operatively, and post-operatively.
Modifier 74 must NOT be appended when ANY of the following apply:
- Procedure was electively discontinued by the patient or physician.
- Unlisted procedure codes are billed.
- Add-on procedure codes are billed.
- Electively cancelled procedures.
- Professional services (Modifier 74 is facility-only).
- Procedure was discontinued prior to administration of anesthesia.

Reimbursement: No reimbursement adjustment is made for services appended with Modifier 74.0

Electively discontinued/electively cancelled procedures

Timing mismatch (e.g., 73 used after anesthesia administered; 74 used prior to anesthesia)

Billing Rule

Reimbursement adjustment for Modifier 73

Claims with Modifier 73 will be reimbursed at 50% of the applicable Fee Schedule allowed amount.

Reimbursement level: 50% of applicable Fee Schedule allowed amount

Billing Rule

Reimbursement for Modifier 74

No reimbursement adjustment is made for services appended with Modifier 74.

No reimbursement adjustment applied

Denial Risk

Policy violations may trigger sanctions

Violations may result in increased auditing/monitoring, performance guarantee penalties, or termination of the contract; disciplinary actions will be determined by the plan.

Increased auditing and monitoring (audits)
Performance guarantee contractual penalties (penalties)
Contract termination or other contract actions

Added prohibition that modifier cannot be used if the patient elects to discontinue the procedure.

2026-02-06administrative_reviewLatest

Annual review recorded (version history includes multiple annual reviews, some marked 'no changes').