1: A physician providing diagnostic or therapeutic radiology services, ultrasound, or nuclear medicine services in a
hospital would use modifier -26 to report the professional component, as follows:
73090-26 = Professional component only for an x-ray of the forearm
2: Two surgeons, usually with different skills, may be required to manage a specific surgical problem. The modifier
-62 would be applicable. Modifier -62 would be appropriate only when both surgeons are reporting the same
code number and descriptor. For instance, a neurological surgeon and an otolaryngologist are working as cosurgeons
in performing transsphenoidal excision of a pituitary neoplasm. The first surgeon would report:
61548-62 = Hypophysectomy or excision of pituitary tumor,
transnasal or transseptal approach, nonstereotactic +
two surgeons modifier
AND the second surgeon would report:
61548-62 = Hypophysectomy or excision of pituitary tumor,
transnasal or transseptal approach, nonstereotactic +
two surgeons modifier
ANESTHESIA GROUND RULES
GENERAL: All anesthesia values are determined by taking the BASIC UNIT VALUE, which is related to
the complexity of the service, and adding MODIFYING UNITS (if any), and TIME UNITS. The fee for a
particular procedure or service in this section is determined by multiplying the listed "Basic Unit Value" by
the conversion factor that is applicable to this section. .
The values contained within this section apply when the anesthesia care is provided by or under the medical
supervision of qualified physician. This anesthesia care may include but is not limited to general, regional,
monitored anesthesia care, supplementation of local anesthesia, or other supportive services in order to
afford the patient the anesthesia care deemed optimal. For anesthesia care provided by nurse anesthetists,
billing for independent unsupervised services, payment will be limited to 85% of the maximum allowable fee
associated with the CPT code submitted.
