Modifier Code 47

I. Description

Modifier code 47 represents anesthesia by the surgeon. The modifier should only be used to represent general anesthesia or a regional block. It should not be used to represent local anesthesia by the surgeon. Local anesthesia is included in the global fee for the surgery and should not be billed separately.

HMSA will allow additional payment for anesthesia by the surgeon for selected procedures only. Most of the procedures for which additional payment is allowed involve the female reproductive system. (See the list below.) No additional allowance is made for anesthesia by the surgeon for surgeries other than those listed.

Example 1 - modifier 47 appropriate
The surgeon will be performing an endometrial biopsy. Prior to surgery, the surgeon initiates a regional block. The surgeon may bill using the CPT code for the biopsy, followed by modifier 47.

Example 2 - modifier 47 not appropriate
The physician injects lidocaine into surrounding tissue prior to repairing a superficial laceration to the patient's index finger.

II. Claims filing instructions

Claims for anesthesia by surgeon should be submitted using two lines. On the first line enter the surgical procedure code. On the second line list the surgical procedure code followed by modifier 47.

For example 1 above, the claim would be completed as follows:

III. Applicable procedure codes

Revision History