Pricing Modifier

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
October 13th, 2015

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 45378G0105G0121)
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:

Pricing Modifier. (2015, October 13). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/pricing-modifier-31630.html

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