(2023) Modifier 47 | Description, Guidelines & Reimbursement

Modifier 47 reports the regional or general anesthesia the attending or assistant surgeon provides. Add modifier 47 to the basic service. This does not include local anesthesia.

Use the 47 modifier only for the CPT codes 10021 through CPT 69990. Report it in the second modifier position.

Description Of Modifier 47

The 47 modifiers can be billed for anesthesia by a surgeon. Report modifier 47 to the primary service but doesn’t include local anesthesia.

The CPT manual defines the modifier as follows: “Anesthesia by Surgeon”

Billing Guidelines

• Use of modifier 47 by the anesthesiologist
• Appending modifier 47 to CPT 00100 – CPT 01999 is prohibited if the same physician performs the anesthesia services. Bundled anesthesia services can’t be reported with a medical/surgical procedure.
• Do not use modifier 47 for local anesthesia.
• Report modifier 47 with the surgical procedure code when the surgeon provides moderate sedation. See CPT codes 99143 through CPT 99145.
• Do not use this modifier if the surgeon monitors general anesthesia performed by an anesthesiologist, CRNA, resident, or intern.
• Do not report CPT 96260 – CPT 96376 for administering anesthetic agents during the procedure.
• The physician can report a subarachnoid/epidural injection.

A separate anesthesia service can be billed by provider two if it is medically reasonable and necessary that the anesthesia practitioner performs the surgical procedure.

Facilities and physicians should not unbundle components of anesthesia and report them instead of an anesthesia code when anesthesia services are not separately reported.

Separate payment for anesthesia services is prohibited if performed by the same physician who provided the surgical or medical service.

Additional Tips

You can assign the CPT code for the procedure twice if the surgeon also used general or regional anesthesia. In that case, you should assign the 47 modifier once to the code, and you should report the code one time without the modifier.

Claims to the payer must include time units for monitoring the patient while they are on anesthesia.

Reimbursement

If the same physician performs anesthesia and surgery, the anesthesia is considered included with the surgery. No separate or additional benefit is available for the anesthesia. The 47 modiifer is informational only and does not affect reimbursement.

The surgeon reimbursed under a global payment policy must provide postoperative pain management services and can’t be reimbursed.

Modifier 47 is not a Medicare-covered benefit.