Reimbursements

Category:

Modifiers 73 and 74

Reimbursement Policy: NDRP-GC-008
Topic: General Coding
Effective Date: July 1, 2018

Description:

 This policy addresses coverage and reimbursement related to the use of Modifiers 73 and 74.

Definitions:

Modifier-73: Discontinuation of Procedure Prior to Administration of Anesthesia
Modifier 73 is used to report an outpatient or ASC procedure that was discontinued prior to the administration of anesthesia.  The discontinuation is usually the result of extenuating circumstances or those that threaten the well- being of the patient.  The physician may cancel a surgical or diagnostic procedure subsequent to the patient’s surgical preparation, but prior to the administration of anesthesia.  Physicians should report discontinued services using Modifier 53.

Modifier-74: Discontinuation of Procedure After Administration of Anesthesia
Modifier 74 is used to report an outpatient or ASC procedure that was discontinued after the administration of anesthesia.  The discontinuation is usually the result of extenuating circumstances or those that threaten the well- being of the patient.  The physician may cancel a surgical or diagnostic procedure subsequent to the patient’s surgical preparation, but prior to the administration of anesthesia.  Physicians should report discontinued services using Modifier 53.

Policy:

The Plan will reimburse approved service lines reporting modifier 73 at 50% of the allowance.

The Plan will reimburse approved service lines reporting modifier 74 at 100% of the allowance

Cross Reference:

  • HCN 397, November 2017