ANESTHESIA MODIFIERS

All anesthesia services are reported by use of the anesthesia five-digit procedure code plus the addition of a physical status modifier. These modifying units may be added to the basic unit value. The use of other optional modifiers may also be appropriate.

Physical Status Modifiers 

Physical status modifiers are represented by the initial letter P followed by a single digit from 1 to 6 as defined below:  

P1 - A normal healthy patient .................................................................................................. 0 

P2 - A patient with mild systemic disease .................................................................................. 0 

P3 - A patient with severe systemic disease ............................................................................... 1 

P4 - A patient with severe systemic disease that is a constant threat to life ............................... 2 

P5 - A moribund patient who is not expected to survive without the operation .......................... 3

P6 - A declared brain-dead patient whose organs are being removed for donor purposes ....................................................................................................................................................... 0 

The above six levels are consistent with the American Society of Anesthesiologists (ASA) ranking of patient physical status. Physical status is included in CPT to distinguish between various levels of complexity of the anesthesia service provided.

TIME UNITS (TM): TIME UNITS WILL BE ADDED TO THE BASIC UNIT VALUE AND MODIFYING UNITS AS IS CUSTOMARY IN THE LOCAL AREA. Anesthesia time begins when the anesthesiologist begins to prepare the patient for anesthesia care in the operating room or in an equivalent area, and ends when the anesthesiologist is no longer in personal attendance, that is, when the patient may be safely placed under other post-anesthesia supervision. 

The time units are calculated by allowing one unit for each 15 minutes or significant fraction thereof (7.5 minutes or more) of anesthesia time. If anesthesia time extends beyond three hours, 1.0 unit for each 10 minutes or significant fraction thereof (5 minutes or more) is allowed after the first three hours. Documentation of actual anesthesia time may be required, such as a copy of the anesthesia record in the hospital file.  

UNLISTED SERVICE OR PROCEDURE: When an unlisted service or procedure is performed, the values used should be substantiated "By Special Report." For an unlisted service or procedure, the health care provider or anesthetist shall establish a unit value consistent with other unit values listed in the schedule. 

MATERIALS SUPPLIED BY HEALTH CARE PROVIDER: Supplies and materials provided by the health care provider or anesthetist (e.g., sterile trays, drugs) over and above those usually included with the office visit or other services rendered may be listed separately. The statement of charges will need to reflect any drugs, trays, supplies, and materials that were provided. Payment shall not exceed the cost of the item(s) to the health care provider plus 25%, or the cost of the item(s) plus $15.00 per item, whichever is less. Use procedure code 99070