Skip to main content

Advertisement

Table 2 Modifiers That Affect Cost

From: Developing a standardized healthcare cost data warehouse

Modifier Type of Service Definition Impact
50 Physician fee and gap schedules Bilateral procedure Increase to 150% of fee/cost
51 Physician fee and gap schedules Multiple procedure Reduce to 50% of fee/cost
62 Physician fee and gap schedules Cosurgeon Reduce to 62.5% of fee/cost
AS, 80, 81, 82 Physician fee and gap schedules Surgery assistant Reduce to 16% of fee/cost
QK Anesthesia Medical direction by a physician of 2, 3, or 4 concurrent anesthesia procedures Reduce to 50% of fee/cost
QX Anesthesia CRNA/AA service with medical direction by a physician Reduce to 50% of fee/cost
QY Anesthesia Medical direction of one CRNA/AA by an anesthesiologist Reduce to 50% of fee/cost
P1 Anesthesia Healthy patient Add 0 units to base
P2 Anesthesia Patient with mild systemic disease Add 0 units to base
P3 Anesthesia Patient with severe systemic disease Add 1 unit to base
P4 Anesthesia Patient with severe systemic disease that is a constant threat to life Add 2 units to base
P5 Anesthesia Moribund patient who is not expected to survive without the operation Add 3 units to base
P6 Anesthesia A patient who has been declared “brain dead” and whose organs are being removed for donor purposes Add 0 units to base
  1. Abbreviations: AA anesthesiologist’s assistance, CRNA certified registered nurse anesthetist