Showing posts with label Modifiers. Show all posts
Showing posts with label Modifiers. Show all posts

Friday, July 22, 2016

Medicare part B modifiers full list

Modifiers to be used for Part B


Program Category Modifier Code Description
PART - B Physician Quality Reporting 1P Physician Quality Reporting System – Performance measure exclusion modifier due to medical reasons.
PART - B Surgical 22 Unusual procedural services.
PART - B E/M 24 Evaluation and Management (E/M) – Unrelated E/M service by the same physician during a postoperative period.
PART - B E/M 25 Significant, separately identifiable Evaluation and Management (E/M) service by the same physician on the same day of the procedure or other service.
PART - B Radiology/Pathology 26 Professional component.
PART - B Physician Quality Reporting 2P Physician Quality Reporting System  – Performance measure exclusion modifier due to patient reasons.
PART - B Physician Quality Reporting 3P Physician Quality Reporting System  – Performance measure exclusion modifier due to system reasons.
PART - B Coding 50 Bilateral procedure.
PART - B Surgical 51 Multiple procedures.
PART - B Coding 52 Reduced services.
PART - B Coding 53 Discontinued procedure. 
PART - B Surgical 54 Surgical care only.
PART - B Surgical 55 Postoperative management only.
PART - B Surgical 56 Preoperative management only.
PART - B E/M 57 Evaluation and Management (E/M) – Decision for surgery.
PART - B Surgical 58 Staged or related procedure or service by the same physician during the postoperative period.
PART - B Coding 59 National Correct Coding Initiative (NCCI) – Distinct procedural service.
PART - B Surgical 62 Two surgeons.
PART - B Surgical 66 Surgical team.
PART - B ASC 73 Ambulatory Surgical Center (ASC) – Discontinued procedure prior to administration of anesthesia.
PART - B ASC 74 Ambulatory Surgical Center (ASC) – Discontinued procedure after administration of anesthesia.
PART - B Coding 76 Repeat procedure by same physician. 
PART - B Coding 77 Repeat procedure by another physician. 
PART - B Surgical 78 Return to the operative room for a related procedure during the postoperative period.
PART - B Surgical 79 Unrelated procedure or service by the same physician during the postoperative period.
PART - B Surgical 80 Assistant surgeon.
PART - B Surgical 81 Minimum assistant surgeon.
PART - B Surgical 82 Assistant surgeon (when qualified resident surgeon not available).
PART - B Physician Quality Reporting  8P Physician Quality Reporting System – Performance measure reporting modifier – action not performed, reason not otherwise specified.
PART - B Laboratory 90 Referenced (outside) laboratory.
PART - B Laboratory 91 Repeat clinical diagnostic laboratory test.
PART - B Coding 99 Multiple modifiers.
PART - B Anesthesia AA Services performed personally by an anesthesiologist.
PART - B Anesthesia AD Medical supervision by a physician, more than four concurrent procedures.
PART - B Psychiatric  AH Clinical psychologist.
PART - B E/M AI Principal physician of record.
PART - B Psychiatric  AJ Clinical social worker.
PART - B HPSA/PSA AQ Physician providing a service in a Health Professional Shortage Area (HPSA).
PART - B HPSA/PSA AR Physician provided service in a Physician Scarcity Area (PSA).
PART - B Surgical AS Physician Assistant (PA), Clinical Nurse Specialist (CNS) or Nurse Practitioner (NP) services for assistant-at-surgery.
PART - B Chiropractic AT Acute treatment.
PART - B Outpatient Hospital AY Item or service furnished to an ESRD patient that is not for the treatment of ESRD.
PART - B Health Professional Shortage Area (HPSA) AZ Physician providing a service in a dental health professional shortage area for the purpose of an Electronic Health Record (EHR) incentive payment.
PART - B ESRD CB Service ordered by a RDF physician as part End Stage Renal Disease (ESRD) beneficiary’s dialysis benefit.
PART - B Coding CC Procedure code change.
PART - B Catastrophe/Disaster CR Catastrophe/Disaster-related claims.
PART - B Disaster-related claims CS Gulf oil spill 2010 related.
PART - B Anatomical E1 Upper left eyelid.
PART - B Anatomical E2 Lower left eyelid.
PART - B Anatomical E3 Upper right eyelid.
PART - B Anatomical E4 Lower right eyelid.
PART - B Drugs EA Erythropoiesis Stimulating Agent (ESA) – Anemia, chemo-induced.
PART - B Drugs EB Erythropoiesis Stimulating Agent (ESA) – Anemia, radio-induced.
PART - B Drugs EC Erythropoiesis Stimulating Agent (ESA) – Anemia, non-chemo/radio.
PART - B Anatomical F1 Left hand, second digit.
PART - B Anatomical F2 Left hand, third digit.
PART - B Anatomical F3 Left hand, fourth digit.
PART - B Anatomical F4 Left hand, fifth digit.
PART - B Anatomical F5 Right hand, thumb.
PART - B Anatomical F6 Right hand, second digit.
PART - B Anatomical F7 Right hand, third digit.
PART - B Anatomical F8 Right hand, fourth digit.
PART - B Anatomical F9 Right hand, fifth digit.
PART - B Anatomical FA Left hand, thumb.
PART - B ASC FB Ambulatory Surgical Center (ASC) – Item provided without cost to provider, supplier or practitioner, or full credit received for replaced device.
PART - B ASC FC Ambulatory Surgical Center (ASC) – Partial credit received for replaced device.
PART - B Anesthesia G8 Monitored Anesthesia Care (MAC) for deep complex, complicated or markedly invasive surgical procedure.
PART - B Anesthesia G9 Monitored Anesthesia Care (MAC) for patient who has history of severe cardiopulmonary condition.
PART - B ABN GA Waiver of liability statement issued, as required by payer policy.
PART - B Resident GC Service performed in part by a resident under the direction of a teaching physician.
PART - B Resident GE Service performed by a resident without the presence of a teaching physician under the primary care exception.
PART - B Radiology GG Performance and payment of a screening mammography and diagnostic mammography on the same patient, same day.
PART - B Opt-Out GJ “Opt-Out” physician or practitioner service provided in an emergency or urgent service.
PART - B Ambulance GM Multiple patients on one ambulance trip.
PART - B PT/OT GN Physical/Occupational Therapy (PT/OT) – Services delivered under an outpatient speech language pathology plan of care.
PART - B PT/OT GO Physical/Occupational Therapy (PT/OT) – Services delivered under an outpatient occupational therapy plan of care.
PART - B PT/OT GP Physical/Occupational Therapy (PT/OT) – Services delivered under an outpatient physical therapy plan of care.
PART - B Telehealth GT Via interactive audio and video telecommunications system.
PART - B Hospice GV Attending physician not employed or paid under arrangement by the patient’s hospice provider. 
PART - B Hospice GW Service not related to the hospice patient’s terminal condition.
PART - B Excluded GY Item or service statutorily excluded or does not meet the definition of any Medicare benefit.
PART - B ABN GZ Advance Beneficiary Notice (ABN) was not signed by the beneficiary.
PART - B CAP J1 “No pay” Competitive Acquisition Program (CAP)modifier for drug line.
PART - B CAP J2 Competitive Acquisition Program (CAP) emergency re-supply.
PART - B CAP J3 Competitive Acquisition Program (CAP) “Furnish as Written.”
PART - B Drugs JW Drug amount discarded/not administered to any patient.
PART - B Drugs  KD Drug or biological infused through Durable Medical Equipment (DME). 
PART - B Medical Policy KX Requirements specified in the medical policy have been met.
PART - B Anatomical LC Left circumflex coronary artery.
PART - B Anatomical LD Left anterior descending coronary artery.
PART - B Laboratory LR Laboratory round trip.
PART - B Eye LS FDA-monitored Intraocular Lens (IOL) implant.
PART - B Anatomical LT Left side.
PART - B CAP MS Competitive Acquisition Program (CAP) Medicare secondary payer.
PART - B Anesthesia P1 Physical Status – A normal healthy patient.
PART - B Anesthesia  P2 Physical Status – A patient with mild systemic disease.
PART - B Anesthesia  P3 Physical Status – A patient with severe systemic disease.
PART - B Anesthesia  P4 Physical Status – A patient with severe systemic disease that is a constant threat to life.
PART - B Anesthesia  P5 Physical Status – A moribund patient who is not expected to survive without the operation.
PART - B Anesthesia  P6 Physical Status – A declared brain-dead patient whose organs are being removed for donor purposes.
PART - B Wrong Procedure PA Surgery wrong body part. Wrong surgical or other invasive procedures performed on a patient.
PART - B Wrong Procedure PB Surgery wrong patient. Wrong surgical or other invasive procedures performed on a patient
PART - B Wrong Procedure PC Wrong surgery on patient. Wrong surgical or other invasive procedures performed on a patient.
PART - B Radiology PI Positron Emission Tomography (PET) or PET/Computed Tomography (CT).
PART - B Radiology PS Positron Emission Tomography (PET) or PET/Computed Tomography (CT).
PART - B Surgical PT Colorectal cancer screening test; converted to diagnostic test or other procedure.
PART - B Clinical Research Studies Q0 Investigational clinical service provided in a clinical research study that is in an approved clinical research study.
PART - B Clinical Research Studies Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study.
PART - B Kidney Q3 Live kidney donor surgery and related services.
PART - B Physician Q5 Service furnished by a substitute physician under a reciprocal billing arrangement.
PART - B Physician Q6 Services furnished by a locum tenens physician.
PART - B Footcare Q7 One class A finding.
PART - B Footcare Q8 Two class B findings.
PART - B Footcare Q9 One class B and two class C findings.
PART - B Prison/Custody QJ Services/items provided to a prisoner or patient in state or local custody; however, the state or local government, as applicable, meets the requirements in 42 CFR 411.4(b).        For outpatient claims, providers should append modifier QJ on all lines with a line item date of service during the incarceration period. All associated charges should be billed as non-covered.
PART - B Anesthesia QK Medical direction of two, three or four concurrent procedures.
PART - B Ambulance QL Patient pronounced dead after ambulance called (do not use origin and destination modifiers, only QL).
PART - B Anesthesia QS Monitored Anesthesia Care (MAC) services.
PART - B Laboratory QW Clinical Laboratory Improvement Amendments (CLIA) waived test.
PART - B Anesthesia QX Certified Registered Nurse Anesthetist (CRNA) service with medical direction by a physician.
PART - B Anesthesia QY Medical direction of one Certified Registered Nurse Anesthetist (CRNA) by an anesthesiologist.
PART - B Anesthesia QZ Certified Registered Nurse Anesthetist (CRNA) service without medical direction by a physician.
PART - B DME RA Replacement of a Durable Medical Equipment (DME), orthotic or prosthetic item.
PART - B Anatomical RC Right coronary artery.
PART - B Anatomical RT Right side.
PART - B ASC SG Ambulatory Surgical Center (ASC) – Facility service.
PART - B Anatomical T1 Left foot, second digit.
PART - B Anatomical T2 Left foot, third digit.
PART - B Anatomical T3 Left foot, fourth digit.
PART - B Anatomical T4 Left foot, fifth digit.
PART - B Anatomical T5 Right foot, great toe.
PART - B Anatomical T6 Right foot, second digit.
PART - B Anatomical T7 Right foot, third digit.
PART - B Anatomical T8 Right foot, fourth digit.
PART - B Anatomical T9 Right foot, fifth digit.
PART - B Anatomical TA Left foot, great toe.
PART - B Radiology/Pathology TC Technical component.
PART - B Radiology UN Portable X-Ray Supplier – Two patients served.
PART - B Radiology UP Portable X-Ray Supplier – Three patients served.
PART - B Radiology UQ Portable X-Ray Supplier – Four patients served.
PART - B Radiology UR Portable X-Ray Supplier – Five patients served.
PART - B Radiology US Portable X-Ray Supplier – Six patients served.

Friday, April 30, 2010

Bilateral surgical procedure modifier - 50

Surgical - 50 Modifier


50 Bilateral Procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same operative session should be identified by adding the modifier 50 to the appropriate five digit code.

Report such procedures as a single line item with a unit of 1. For example, when procedure code 19180 ( Mastectomy, simple, complete) is performed bilaterally, report the service as 1918050.

If a procedure is identified by the terminology as bilateral ( or unilateral or bilateral), do NOT report the procedure code with modifier 50. For example, procedure code 68810 to 68815, ( probing of nasolacrimal duct, with or without irrigation, unilateral or bilateral) includes terminology which indicates the procedure is performed either unilaterally or bilaterally. Therefore it’s not appropriate to report this modifier with this code.

Additionally some procedure codes, i.e., 52000 ( Cystourethroscopy, separate procedure) should NOT be reported with the 50 modifier since anatomy does not permit this procedure to be performed bilaterally.

Medical billing Modifiers 79 & 59

Global Surgery - 79 Modifier

79 Unrelated Procedure by the Same Physician During the Postoperative Period:
The physician may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. This circumstance may be reported by using the modifier 79.

A repair of a femoral hernia (49550) is performed on January 5, 2007. The postoperative period designation for this procedure code is 90 days.

On February 12, 2007, the same physician performs an appendectomy. The physician should report the appendectomy as 4495079.


Global Surgery - 59 Modifier

59 Distinct Procedural Service: Under certain circumstances, a provider may need to indicate that a procedure or service was independent from the services performed on the same day. See Appendix C (Correct Coding Initiative) for more information regarding the use of modifier 59.

Monday, April 26, 2010

Modifier 24 - Unrelated Evaluation and Management Service

Global Surgery - 24 Modifier

The following modifiers are used by physicians to indicate a billed service is not part of a global surgical package and is eligible for separate reimbursement:

24  - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: The physician may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. This circumstance may be reported by adding the modifier 24 to the appropriate level of E/M service.

An excision of a malignant lesion on the left arm is performed in the office on January 10, 2007. The ICD-9-CM diagnosis code reported is 171.2. The postoperative period designated for excision code 11606 is 10 days.

The patient returns to the office on January 15, 2007 and is treated for contact dermatitis, ICD-9-CM code 692.0. The physician should report the appropriate evaluation and management code followed by the 24 modifier, e.g., 9921224.

In order for the evaluation and management service to be payable in the postoperative period with the 24 modifier, the diagnosis code supporting the E/M service must be different from the diagnosis code reported for the previously performed surgery.

Modifier 24 should not be used for the medical management of a patient by the surgeon following surgery. Medicare recognizes modifier 24 only for the care following a discharge under these circumstances:

  • The care is for immunotherapy management furnished by the transplant surgeon;
  • The care is for critical care (99291, 99292) for a burn or trauma patient under diagnosis codes 800.0-929.9, 940.0-959.9; or
  • The documentation demonstrates that the visit occurred during a subsequent hospitalization and the diagnosis supports the fact that it is unrelated to the original surgery.

Monday, April 12, 2010

What is Modifiers

Part A Modifiers - Medicare

Introduction
A modifier is a two position alpha or numeric code that is added to the end of a HCPCS code to

clarify the services/procedures that are performed on the same calendar day. The dash that is
often seen preceding a modifier should never be reported.

Modifiers provide a means by which a service can be altered without changing the procedure
code. They add more information, such as anatomical site, to the HCPCS code. In addition, they
help to eliminate the appearance of duplicate billing and unbundling.

There are CPT-4 and Level II HCPCS modifiers. They are used to increase accuracy in
reimbursement, coding consistency, editing and to capture payment data.


NOT ALL HCPCS CODES WILL REQUIRE MODIFIERS.

This guidelines of when a modifier is required. A modifier should NOT be used to indicate:

• An anatomical site location on body if the narrative definition of a HCPCS code indicates
multiple occurrences

EXAMPLE: 73565 (Radiological examination, both knees, standing, anteroposterior).
It would be inappropriate to apply a modifier because the definition of this
Particular HCPCS code (73565) includes “both knees”.

• An anatomical site if the narrative definition of a HCPCS code indicates the procedure
applies to more than two sites.

EXAMPLE: 11600 (Excision, malignant lesion including margins, trunk, arms, or legs;
excised diameter 0.5 cm or less)
It would be inappropriate to apply a modifier to identify a particular anatomical site on the body when it is included (along with other anatomical sites) in the HCPCS code description.

When it is appropriate to use a modifier, the most specific modifier should be used first. Up to two (2) sets of modifiers can be used per line item. Level I modifiers should generally be used before Level II HCPCS modifiers. However, when modifiers E1 through E4, FA through F0, LC, LD, RC and TA-T9 apply, they should be used before modifiers LT, RT, or –59.

Saturday, March 6, 2010

CPT modifiers 21, 22 and 26

Medicare Part B modifiers - 26

Professional Component: Certain procedures are a combination of a physician component and a technical component. When the physician component is reported separately, the service may be identified by adding the modifier 26 to the usual procedure number.
Medicare Part B modifiers - 22

Unusual Procedural Services: When the service(s) provided is greater than what is usually required for the listed procedure, indicate this by adding modifier 22 to the procedure code. A report is also required. For services on the physician fee schedule, modifier 22 is applicable only to those procedure codes for which the global surgery concept applies, whether the procedure code is surgical in nature or not. Supportive documentation, e.g., operative reports, progress notes, order sheets, pathology reports, etc., must be submitted with the claim. Note: Modifier 22 will be removed when reported with procedures that do not have a global surgery period of 0, 10, or 90 days.
Medicare Part B modifiers - 21

Prolonged Evaluation and Management Service: When the face-to-face or floor/unit service(s) provided is prolonged or otherwise greater than that usually required for the highest level of evaluation and management service within a given category, it may be identified by adding a modifier to the evaluation and management code number. A report may also be appropriate.

Wednesday, March 3, 2010

Medical billing Modifiers 54 & 55

Medicare Part B modifiers - 54
Surgical Care Only: When one physician performs a surgical procedure and another
provides preoperative and/or postoperative management, surgical services may be identified
by adding the modifier 54 to the usual procedure code.

Services billed with a 54 modifier will be reimbursed at the intraoperative
allowance for the surgical procedure. The intraoperative allowance includes the
one day preoperative care, the intraoperative service, as well as any in-hospital
visits that are performed.

Medicare Part B modifiers - 55 Postoperative Management Only:

When one physician performs the postoperative management and another physician has performed the surgical procedure, the postoperative component may be identified by adding the modifier 55 to the usual procedure number. This modifier is used to identify postoperative, out of hospital medical care associated with a given surgical procedure. When billing for postoperative care only, report the original date of surgery as your date of service and the procedure code for the surgical procedure followed by the 55 modifier.

In rare situations where the out of hospital postoperative care is split between physicians, each physician must also indicate the period of his/her responsibility for the patient’s postoperative care by reporting the appropriate range of dates. Where a transfer of postoperative care occurs, the receiving physician cannot bill for any part of the global services until he/she has provided at least one service.

CPT modifers 59 , 78 and 79

Medicare Part B modifiers - 59

Distinct Procedural Service: Under certain circumstances, a provider may need to
indicate that a procedure or service was independent from the services performed on the
same day.
Medicare Part B modifiers - 78
Return to the Operating Room for a Related Procedure During the Postoperative Period: The physician may need to indicate that another procedure was performed during the postoperative period of the initial procedure. When this subsequent procedure is related to the first, and requires the use of the operating room, it may be reported by adding the 78 modifier to the related procedure. When treatment for complications requires a return trip to the operating room, physicians must bill the CPT-4 code that describes the procedure(s) performed during the return trip. If no such code exists, use the unspecified procedure code in the correct series, e.g., 47999 or 64999. In this situation, you must include operative notes with the claim or a narrative description which will allow us to understand the extent of the service performed. The procedure code for the original surgery is not used except when the identical procedure is repeated. An operating room for this purpose is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite and an endoscopy suite. It does not include a patient’s room, a minor treatment room, a recovery room or an intensive care unit ( unless the patient’s condition was so critical there would be insufficient time for transportation to an operating room).
Medicare Part B modifiers - 79
Unrelated Procedure by the Same Physician During the Postoperative Period: The physician may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. This circumstance may be reported by using the modifier 79.

Thursday, February 18, 2010

Medicare Part - B Modifier -25

Medicare Part - B Modifier -25

Separately Identifiable Evaluation and Management Service by the Same Physician on the Day of a Procedure or Other Service: The physician may need to indicate that on the day a procedure or service identified by a CPT code was performed, the patient’s condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. The E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E/M services on the same date. This circumstance may be reported by adding the modifier 25 to the appropriate level of E/M service.

Visits by the same physician on the same day as a minor surgery or endoscopy are included in the payment for the procedure, unless a significant, separately identifiable service is also performed. For example, a visit on the same day could be properly billed with the 25 modifier in addition to billing for suturing a scalp wound if a full neurological examination was made for a patient with head trauma. Billing for a visit would not be appropriate if the physician only identified the need for sutures and confirmed allergy and immunization status. In the circumstance when the decision to perform a minor procedure is typically done immediately before the service, (e.g., whether or not sutures are needed to close a wound, whether or not to remove a mole or wart, etc.) it is considered a routine preoperative service and a visit or consultation should not be reported in addition
to the procedure.

Separate payment may be made for an initial hospital visit (CPT codes 99221-99223), an initial inpatient consultation (CPT codes 99251-99255) and a hospital discharge service (CPT codes 99238 and 99239) when billed by the same physician for the same date as an inpatient dialysis service (CPT codes 90935-90947). It is no longer required that these evaluation and management services be unrelated to the treatment of the patient’s ESRD in order for payment to be made. However, the 25 modifier must still be reported with these evaluation and management services in order to indicate that they are significant and separately identifiable services. Physicians may request reviews of previously denied services.

Medicare Part B Modifier - 24

Medicare Part B Modifier - 24

Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: The physician may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. This circumstance may be reported by adding the modifier 24 to the appropriate level of E/M service.

In order for the evaluation and management service to be payable in the postoperative period with the 24 modifier, the diagnosis code supporting the E/M service must be different from the diagnosis code reported for the previously performed surgery.

Donot Use Modifier - 24

Modifier 24 should not be used for the medical management of a patient by the surgeon following surgery.

Medicare recognizes modifier 24 only for the care following a discharge under these circumstances:

The care is for immunotherapy management furnished by the transplant surgeon;
The care is for critical care (99291, 99292) for a burn or trauma patient under diagnosis codes 800.0-929.9, 940.0-959.9; or The documentation demonstrates that the visit occurred during a subsequent hospitalization and the diagnosis supports the fact that it is unrelated to the original surgery.

Wednesday, February 17, 2010

Medicare Part B - Modifiers - Anesthesia

Introduction

A list of the most frequently used CPT (Current Procedural Terminology) modifiers, HCPCS
(Healthcare Common Procedure Coding System) modifiers, and local modifiers has been
compiled for your reference.

These modifiers and associated nomenclature emanated from two different sources.

Physician’s Current Procedure Terminology, CPT 1999 was used for the definition of CPT4
numeric modifiers with one modification. The five digit modifiers identified in the CPT
are not included in these definitions since the Medicare program does not recognize
reporting modifiers in this format.

The HCPCS (Healthcare Common Procedure Coding System) alpha modifiers were
developed by Centers for Medicare & Medicaid Services (CMS) for use in the Medicare
program.

For some of these modifiers, additional clarification (shown as indented text) has been added,
as well as examples. Other modifiers are self-explanatory; no additional comment is provided.

Modifiers provide the means by which the reporting provider can indicate a service or procedure
that has been performed has been altered by some specific circumstance but not changed in
its definition or code.

Modifiers may be used to indicate that:

a service or procedure has both a professional and technical component
a service or procedure was performed by more than one physician
a service or procedure has been increased or reduced
only part of a service was performed
an adjunctive service was performed
a bilateral procedure was performed
a service or procedure was provided more than once
unusual events occurred


Anesthesia

One of the following modifiers must be reported with anesthesia services to indicate who
performed the anesthesia service:

AA Anesthesia services performed personally by anesthesiologist
AD Medical supervision by a physician: more than four concurrent anesthesia procedures
QK Medically directed by a physician: two, three, or four concurrent procedures
QY Anesthesiologist medically directs one CRNA
QX CRNA service: with medical direction by a physician
QZ CRNA service: without medical direction by a physician
The following modifiers can be reported in the 2nd position under appropriate circumstances
in addition to one of the previous anesthesia modifers:

QS Monitored anesthesia care service
23 Unusual anesthesia
Note: When using modifier 23, appropriate documentation must be submitted with the
claim.

Most read cpt modifiers