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PAP503

CPT Modifier 47


Provider Administrative Policy

Section
Physician
Policy Date
July 2007
Status/Date
Revised/July 2012
Provider Type(s)
Physician  

Disclaimer

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.

Policy

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 do not cover general anesthesia when provided by the same physician performing the surgery.

Even though we do not reimburse for anesthesia as described above, to expedite your claim, please use modifier 47 with your surgery procedure code to indicate that the surgeon (not an anesthesiologist) provided anesthesia.

Exception: If a surgeon bills for regional blocks (CPT codes 64400-64484 and 64505-64530), the codes can be allowed if submitted with a 47 modifier.


Policy History

Date Action Reason
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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