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 |