Modifier 74 — Discontinued Outpatient/ASC Procedure after Anesthesia
Defines when Premera recognizes Modifier 74 on outpatient hospital or ambulatory surgical center (ASC) facility claims to indicate a procedure was discontinued after administration of anesthesia; applies to Premera and affiliated lines of business.
This policy is archived effective March 5, 2026 and readers are referred to the Modifier 73 & 74 Discontinued Procedures Outpatient Hospital/Ambulatory Surgery Center policy.
Clarified that modifier 74 is applicable to surgical procedures that require anesthesia and identified kinds of anesthesia included (local/regional/moderate/deep/general).
Added a paragraph listing situations when modifier 74 must not be appended (elective discontinuation by patient/physician, unlisted codes, add-on codes, professional services, or prior to anesthesia).
Modifier 74 — When Recognized
Modifier 74 coverage criteria
Covered when ALL of the following are met:
Requirement
- The procedure was a surgical or diagnostic procedure that requires anesthesia at an outpatient hospital or ambulatory surgical center (ASC).
- The procedure was discontinued after administration of anesthesia or after the procedure was started (for example: incision made, intubation started, etc.).
Anesthesia
- Anesthesia was administered (includes local blocks, regional blocks, moderate sedation, deep sedation, or general anesthesia).
Documentation required
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