modifier 47, 47 modifier

Modifier 47 – Description, Guidelines & Reimbursement

Modifier 47 is used to report regional or general anesthesia provided by the attending or assistant surgeon. 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.

Modifier 47 Description

The 47 modifier can be billed for Anesthesia by Surgeon. Report modifier 47 to the basic service but don’t include local anesthesia. The modifier is defined by the CPT manual as follows: “General or regional or anesthesia provided by the surgeon.”

Billing Guidelines

  • Use of modifier 47 by the anesthesiologist
  • Appending modifier 47 to CPT 00100 – CPT 01999 is not allowed if the anesthesia services is performed by the same physician. 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 is monitoring general anesthesia performed by an anesthesiologist, CRNA, resident, or intern.
  • Do not report CPT 96260 – CPT 96376 for the administration of anesthetic agents during the procedure.
  • An subarachnoid/epidural injection can be reported by the physician.

A separate anesthesia service can be billed by provider two if it is medically reasonable and necessary that the surgical procedure is performed by the anesthesia practitioner. Facilities and physicians should not unbundle components of anesthesia and report them instead of an anesthesia code when anesthesia services are not separately reported. Seperate payment for anesthesia services are not allowed if performed by the same physician who provided the surgical or medical service.

47 Modifier Reimbursement

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

The surgeon who is reimbursed under a global payment policy has to provide postoperative pain management services and can’t be reimbursed.

Modifier 47 is not a Medicare covered benefit.

Similar Posts

Leave a Reply

Your email address will not be published. Required fields are marked *