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CPT Modifier 47

Provider Administrative Policy

Policy Date
July 2007
Revised/January 2015
Provider Type(s)


Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts


CPT Modifier 47

Blue Cross of Idaho does not reimburse for surgeon-provided anesthesia because surgical procedures are defined as including the operation, local infiltration, metacarpal/digital block or topical anesthesia. Blue Cross of Idaho member contracts only cover general anesthesia when provided and billed by an anesthesiologist or nurse anesthetist. We do not cover general anesthesia when provided by the physician performing the surgery.

Since Modifier 47 is informational only and will not lead to a higher allowance or benefit, we discourage the use of modifier 47 at all.

If you must use modifier 47 for tracking or reporting purposes, please only use it in situations involving regional blocks.

In cases where a surgeon bills for regional blocks (CPT codes 64400-64484 and 64505-64530), covered surgery codes(s) may be allowed if submitted with a 47 modifier. If we receive a surgery code with a modifier 47 and there is not a regional block CPT code on the claim, our Medical Management department will request records to decide if the modifier is being used to report general anesthesia only. If we find that the physician administered general anesthesia in addition to performing the surgery, the claim will deny provider liability for contracting providers.

Policy History

Date Action Reason
January 2015 Revised Added clarifying language
July 2012 Revised updated CPT codes that can be allowed with a 47 modifier
November 2008 Revised Language clarification
May 2008 Revised Title change

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