ModifiedPremera BluecrossPolicy CP.PP.245.v3.1

Modifier 73-Discontinued Outpatient Hospital/Ambulatory Surgery Center Procedure Prior to Administration of Anesthesia

Defines Premera Blue Cross (and affiliates) facility billing recognition and reimbursement rules for discontinued outpatient/ASC procedures using modifiers 73 and 74, including allowed uses, prohibitions, documentation requirements, and reimbursement adjustments.

Policy Summary

PayerPremera Bluecross

PolicyModifier 73-Discontinued Outpatient Hospital/Ambulatory Surgery Center Procedure Prior to Administration of Anesthesia

Policy CodePolicy CP.PP.245.v3.1

Change TypeMODIFIED — added modifier 74, clarified anesthesia and documentation, prohibited elective cancellations

Effective Date

Next Review Date

Key ActionMedical records must document why and when the physician decided to cancel the procedure, which services and supplies were/weren't rendered, and time spent preoperatively (and operatively/post-operatively for modifier 74).

SourceLink

POLICY UPDATE CHANGES

Policy name changed to include both Modifiers 73 & 74 and modifier 74 details were added from archived policy.

Clarified kinds of anesthesia included and required documentation to support use of modifiers.

Added explicit prohibition on using modifiers 73/74 for electively discontinued procedures by patient or physician.

Consolidated guidance that modifier 53 should not be appended for discontinued ASC or outpatient facility services.

2Recognized Modifiers

50%

Reimbursement rate when Modifier 73 applied

0Reimbursement adjustment for Modifier 74

Policy summary

Scope: Defines Premera Blue Cross (and affiliates) facility billing recognition and reimbursement rules for discontinued outpatient/ASC procedures using modifiers 73 and 74, including allowed uses, prohibitions, documentation requirements, and reimbursement adjustments. Subject: Modifiers 73 & 74 - Discontinued Outpatient/ASC Procedures. Payer/Policy Number: Premera Blue Cross — CP.PP.245.v3.1. Background: This policy governs facility-level billing for discontinued outpatient hospital or ambulatory surgical center (ASC) procedures using modifier 73 (discontinued prior to administration of anesthesia and before the procedure started) and modifier 74 (discontinued after administration of anesthesia or after the procedure was started). It cross-references modifier 52 as an alternative for reduced services when no anesthesia is involved and modifier 53 for professional discontinued procedures. Key reimbursement highlights: services appended with modifier 73 are reimbursed at 50% of the applicable fee schedule allowed amount; services appended with modifier 74 receive no reimbursement adjustment (full allowed amount). Effective/Review/Status: Last approval/last review 02/06/26; Policy Number CP.PP.245.v3.1; Status MODIFIED.

Policy metadata

Policy (subject)Modifiers 73 & 74 - Discontinued Outpatient/ASC Procedures

Policy NumberCP.PP.245.v3.1

PayerPremera Blue Cross

StatusMODIFIED

Last review date2026-02-06

Effective dateOriginal Effective Date / see policy

Next reviewSee policy/version history

Key actionsAppend modifier 73 before anesthesia; 74 after anesthesia/start; use 52 for non-anesthesia facility discontinued services; 53 applies to professional claims only

Recognition criteria for discontinued procedures

Modifier 73 - Discontinued Prior to Anesthesia (Facility claim)

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

ALL of the following

Procedure is an outpatient hospital or ambulatory surgical center (ASC) facility service that requires anesthesia and was discontinued prior to the administration of anesthesia and before the surgical procedure was started.
Patient was already wheeled into the surgical suite.
Modifier 73 is appended to the intended surgical procedure code representing the discontinued ASC or outpatient facility service.
Documentation in the medical records lists why and when the physician decided to cancel the procedure, services and supplies that were/were not rendered, and the time spent preoperatively.

Code guidance and prohibited code types

Prohibited code types with Modifiers 73 or 74 (facility)mixedNot Covered

unlisted	Unlisted procedure codes - not to be appended with modifiers 73 or 74
add-on	Add-on procedure codes - not to be appended with modifiers 73 or 74
professional	Professional service procedure codes - modifiers 73/74 are for facility claims only

Alternative modifier for non-anesthesia discontinued servicesHCPCS

52	Modifier 52 - Reduced Services (facility use for discontinued services not requiring anesthesia)

Professional discontinued procedure modifierHCPCS

53	Modifier 53 - Discontinued Procedure (applies to professional services)

Clarification: Modifiers 73 and 74 apply to facility claims only (outpatient hospital or ASC facility services). Modifier 53 is a professional services discontinued-procedure modifier and is not appropriate on facility claims (CMS-1500/837P professional claims). The policy explicitly states that unlisted procedure codes, add-on procedure codes, and professional service procedure codes are not appropriate for appending modifier 73 or 74, and elective cancellations by the patient or physician are prohibited uses for these modifiers.

Billing, documentation, and audit risk

Billing Rule

Append correct modifier to facility claim

Append modifier 73 to the intended surgical procedure code for discontinued outpatient hospital/ASC procedures that were stopped prior to administration of anesthesia and before the procedure started. Append modifier 74 to the ASC or outpatient facility surgical procedure code that was discontinued after the administration of anesthesia or after the procedure was started (e.g., incision made, intubation started). Do not append modifiers 73 or 74 on professional (physician) claims — these modifiers apply to facility claims only.

Documentation Required

Document rationale and timing

Document in the medical record why and when the physician decided to cancel the procedure, which services and supplies were or were not rendered, and the time spent preoperatively. For procedures discontinued after anesthesia or after the procedure was started (modifier 74), also document operative and post‑operative time.

Key terms

Definitions

Anesthesia (per policy)Includes local, regional block(s), moderate sedation/analgesia ('conscious sedation'), deep sedation/analgesia, and general anesthesia.

Policy changes over time

02/06/26revisedLatest

Policy name changed to include both Modifiers 73 & 74 and modifier 74 details were added from archived policy (is_material: true).

04/08/22clarified

Clarified kinds of anesthesia included (local, regional block(s), moderate sedation/analgesia, deep sedation/analgesia, general anesthesia) and required documentation elements to support use of modifiers (is_material: true).

08/17/20added

Policy Summary

PayerPremera Bluecross

PolicyModifier 73-Discontinued Outpatient Hospital/Ambulatory Surgery Center Procedure Prior to Administration of Anesthesia

Policy CodePolicy CP.PP.245.v3.1

Change TypeMODIFIED — added modifier 74, clarified anesthesia and documentation, prohibited elective cancellations

Effective Date

Next Review Date

SourceLink

On This Page

Modifier 73 must not be appended in conjunction with any of the following

any ASC or outpatient facility procedure that was electively discontinued by the patient or physician.
unlisted procedure codes
electively cancelled procedures
add-on procedure codes
professional services
after the administration of anesthesia

title": "Modifier 73 - Discontinued Prior to Anesthesia (Facility claim)"

Modifier 74 - Discontinued After Anesthesia or After Start of Procedure (Facility claim)

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

ALL of the following

Procedure is an outpatient hospital or ambulatory surgical center (ASC) facility surgical procedure that was discontinued after the administration of anesthesia or after the procedure was started (e.g., incision made, intubation started).
Modifier 74 is appended to the ASC or outpatient facility surgical procedure code that was discontinued after anesthesia or start of procedure.
Documentation in the medical records 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 in conjunction with any of the following
- any ASC or outpatient facility procedure that was electively discontinued by the patient or physician
- unlisted procedure codes
- add-on procedure codes
- electively cancelled procedures
- professional services
- prior to the administration of anesthesia

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Alternative for Non-Anesthesia Discontinued Services

When services do not require anesthesia (facility billing):

ALL of the following

Facilities may append modifier 52 (Reduced Services) for discontinued services that do not require anesthesia (e.g., radiology services).

Professional Services

Professional billing guidance:

Modifier 53 (Discontinued Procedure) applies to professional services (CMS-1500/837P) and should not be appended for discontinued ASC or outpatient facility services.

Billing Rule

Reimbursement adjustment for Modifier 73

Services appended with modifier 73 will be reimbursed at 50% of the applicable fee schedule allowed amount.

Billing Rule

Reimbursement for Modifier 74

Reimbursement is not adjusted for services appended with modifier 74.

Denial Risk

Prohibited uses risk denial or audit

Appending modifiers 73 or 74 in prohibited circumstances can lead to audit, monitoring, penalties, or contract actions.

Prohibited uses: elective discontinuations by patient or physician; unlisted procedure codes; add‑on procedure codes; professional service procedure codes (these modifiers are for facility claims only); appending modifier 73 when the discontinuation occurred after anesthesia or appending modifier 74 when discontinuation occurred prior to anesthesia.
Potential consequences: increased auditing and monitoring, performance guarantee contractual penalties, termination of contract, and other disciplinary actions determined by the plan.

Added explicit prohibition on using modifiers 73/74 for electively discontinued procedures by patient or physician (is_material: true).

02/05/24revised

Consolidated guidance that modifier 53 should not be appended for discontinued ASC or outpatient facility services and clarified that modifier 53 applies to professional services only (is_material: false).