by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Oct 13th, 2015 - Reviewed/Updated Aug 7th
Place the modifiers listed below (except modifiers with an *) to the right of the procedure code in Item 24D on the CMS 1500 claim form or for ANSI X12 4010 electronic claims submission use segment 2-370-SV101-3.
Processing delays can occur for claims submitted without the pricing modifier in the first modifier position. However, these payment modifiers are not limited to the first position. (If there is another pricing modifier submitted that is required to be in the first modifier field, these modifiers should be in the second, third or fourth modifier position.)
** If multiple pricing or payment modifiers are submitted, the KD modifier should be placed in the first modifier position field
| AA | Anesthesia service personally performed by anesthesiologist |
| AD | Medical supervision by a physician; more than four concurrent anesthesia procedures |
| AS* | Assistant at surgery services provided by a Physician Assistant (PA) or Nurse Practitioner (NP) |
| KD** | Drug administered through a DME infusion pump |
| QK | Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals |
| QW | CLIA waived tests |
| QX | Certified Registered Nurse Anesthetist (CRNA) service: with medical direction by a physician |
| QY | Medical direction of one CRNA by an anesthesiologist |
| QZ | CRNA service: without medical direction by a physician |
| TC | Technical component |
| 26 | Professional component |
| 50* | Bilateral Procedure performed at the same session on an anatomical site |
| 53 | Discontinued procedure (only when appended to procedure codes 45378, G0105, G0121) |
| 54* | The surgeon is billing the surgical care only |
| 55* | Indicate a physician, other than the surgeon, is billing for part of the outpatient postoperative care Or: Used by the surgeon when providing only a portion of the post-discharge post-operative care |
| 62* | Two surgeons (each in a different specialty) are required to perform a specific procedure |
| 66* | Team surgeons |
| 73* | Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) procedure prior to the administration of anesthesia |
| 78* | Return to an operating room for a related procedure during the postoperative period |
| 80* | Assistant at surgery service is provided by a medical doctor (MD) |
| 81* | To identify minimum surgical assistant services, and is only submitted with surgery codes. |
| 82* | Assistant at surgery service provided by a MD when there is no qualified resident available |
Pricing or Payment Modifier Fact Sheet
References/Resources
About Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Christine Woolstenhulme, CPC, QCC, CMCS, CMRS, is a Certified coder and Medical Biller currently employed with Find-A-Code. Bringing over 30 years of insight, business knowledge, and innovation to the healthcare industry. Establishing a successful Medical Billing Company from 1994 to 2015, during this time, Christine has had the opportunity to learn all aspects of revenue cycle management while working with independent practitioners and in clinic settings. Christine was a VAR for AltaPoint EHR software sales, along with management positions and medical practice consulting. Understanding the complete patient engagement cycle and developing efficient processes to coordinate teams ensuring best practice standards in healthcare. Working with payers on coding and interpreting ACA policies according to state benchmarks and insurance filings and implementing company procedures and policies to coordinate teams and payer benefits.
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