RetiredPremera BluecrossPolicy CP.PP.146.v3.0

Modifier 74 – Discontinued ASC Procedure after Administration of Anesthesia

Defines when Premera recognizes HCPCS/CPT modifier 74 on outpatient hospital/ASC facility claims to indicate a procedure was discontinued after anesthesia was administered or after the procedure was started; applies to Premera lines of business and affiliates.

Policy Summary

PayerPremera Bluecross

PolicyModifier 74 – Discontinued ASC Procedure after Administration of Anesthesia

Policy CodePolicy CP.PP.146.v3.0

Change TypeArchive / Clarifications / Additions

Effective Date

Next Review Date

Key ActionDocument why and when the physician decided to cancel the procedure, the services and supplies that were or were not rendered, and time spent preoperatively, operatively, and post-operatively; this documentation supports appropriate use of modifier 74.

SourceLink

POLICY UPDATE CHANGES

Policy archived effective March 5, 2026 and users are directed to refer to the Modifier 73 & 74 - Discontinued Procedures Outpatient Hospital/Ambulatory Surgery Center policy.

Clarified kinds of applicable anesthesia (local/regional/moderate sedation/deep sedation/general) that qualify for modifier 74.

Added requirement that medical record must contain rationale and timing for discontinuation and details of services/supplies and time periods.

Added explicit disallowed uses of modifier 74 including elective discontinuation, unlisted/add-on codes, professional services, and discontinuation prior to anesthesia.

1Primary Modifier Covered (facility)

5Disallowed Scenarios Listed

Policy summary

Background: This payment policy defines appropriate facility billing when a procedure at an ASC or outpatient hospital setting is discontinued after administration of anesthesia. It cross-references modifier 73 (pre-anesthesia discontinuation) and modifier 53 (professional discontinued procedure). Scope: Defines when Premera recognizes HCPCS/CPT modifier 74 on outpatient hospital/ASC facility claims to indicate a procedure was discontinued after anesthesia was administered or after the procedure was started; applies to Premera lines of business and affiliates. Reimbursement is subject to member eligibility, benefit limits, claim edits, and provider scope of practice. Policy status: RETIRED. Policy number: CP.PP.146.v3.0. Subject: Modifier 74 – Discontinued ASC/Outpatient Procedure after Administration of Anesthesia.

Policy Metadata

Policy TitleModifier 74 – Discontinued ASC/Outpatient Procedure after Administration of Anesthesia

Policy NumberCP.PP.146.v3.0

PayerPremera Bluecross

StatusRETIRED

Last Review2026-02-06

Archive Year2026

Primary Modifier Covered (facility)1

Disallowed Scenarios Listed5

When modifier 74 is recognized and when it is not

When Modifier 74 is Recognized

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

ALL of the following

The service is an ASC or outpatient hospital facility surgical or diagnostic procedure that requires anesthesia.
The procedure was discontinued after the administration of anesthesia or after the procedure was started (e.g., incision made, intubation started).
Anesthesia includes local blocks, regional blocks, moderate sedation, deep sedation, or general anesthesia.
Modifier 74 is appended to the facility surgical procedure code that was discontinued.

Relevant modifiers and coding notes

Modifier referencedModifier

74	Discontinued Outpatient Hospital/ASC Procedure after Administration of Anesthesia (facility claim)
73	Discontinued Outpatient Hospital/ASC Procedure Prior to Administration of Anesthesia (facility claim) - referenced cross-policy
53	Discontinued Procedure - professional services (not to be appended on facility discontinued ASC/outpatient facility services)

Coding guidance: Modifier 74 is appended only to the ASC or outpatient facility surgical procedure code that was discontinued and is recognized when the procedure was discontinued after administration of anesthesia (or after the procedure was started). Modifier 74 is appended on facility claim forms and must not be appended to professional service claims. Use modifier 73 for discontinued ASC/outpatient facility procedures that were discontinued prior to administration of anesthesia. Modifier 74 must NOT be appended to unlisted procedure codes, add-on procedure codes, professional services, or for elective discontinuations or discontinuations that occurred prior to anesthesia.

Billing rules and documentation requirements

Documentation Required

Medical Record Documentation Required

Document in the medical record why and when the physician decided to cancel the procedure, the services and supplies that were or were not rendered, and the time spent preoperatively, operatively, and post‑operatively to support appropriate use of modifier 74.

Billing Rule

Append Modifier 74 to Facility Procedure Code Only

Append modifier 74 to the ASC or outpatient facility surgical procedure code that was discontinued when billed on a facility claim form. Do not append modifier 74 to professional service claims; it is for facility procedure codes only.

Key definitions

Definitions

TermAnesthesia

DefinitionIncludes local blocks, regional blocks, moderate sedation, deep sedation, or general anesthesia as stated in the policy.

Policy changes and archive

2026-03-05archivedLatest

Policy archived effective March 5, 2026 and users are directed to refer to the Modifier 73 & 74 - Discontinued Procedures Outpatient Hospital/Ambulatory Surgery Center policy. (Archive noted in version history; indicates consolidation into combined policy.)

2024-02-05added

Added explicit disallowed uses of modifier 74 including elective discontinuation, unlisted procedure codes, add-on procedure codes, professional services, and discontinuation prior to the administration of anesthesia. (Added as fifth paragraph in 2024-02-05 update.)

2018-10-11clarified

Policy Summary

PayerPremera Bluecross

PolicyModifier 74 – Discontinued ASC Procedure after Administration of Anesthesia

Policy CodePolicy CP.PP.146.v3.0

Change TypeArchive / Clarifications / Additions

Effective Date

Next Review Date

SourceLink

On This Page

Medical record documentation indicates why and when the physician decided to cancel the procedure, services and supplies rendered or not rendered, and time spent preoperatively, operatively, and post-operatively.

When Modifier 74 Must Not Be Appended

Modifier 74 must NOT be appended in any of the following situations (ANY of):

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.
Professional services.
Prior to the administration of anesthesia.

Billing Rule

Do Not Append Modifier 74 in Prohibited Situations

Modifier 74 must not be appended in the following situations:

Any ASC or outpatient facility procedure electively discontinued by the patient or physician
Unlisted procedure codes
Add-on procedure codes
Professional services
Discontinuation that occurred prior to the administration of anesthesia

Billing Rule

Refer to Modifier 73 for Pre-Anesthesia Discontinuation

Use modifier 73 (Discontinued Outpatient Hospital/ASC Procedure Prior to Administration of Anesthesia) for discontinued ASC/outpatient facility procedures that are stopped prior to administration of anesthesia; modifier 73 is appended on the facility claim.

Clarified kinds of applicable anesthesia (local blocks, regional blocks, moderate sedation, deep sedation, general anesthesia) that qualify for modifier 74. (Added language to specify anesthesia types applicable.)

2018-08-02clarified

Expanded documentation expectations: medical record must indicate why and when the physician decided to cancel the procedure, services and supplies rendered or not rendered, and time spent preoperatively, operatively, and post-operatively. (Documentation expectations were expanded over several revisions.)