CMS issued clarification in 2013 (Transmittal 2716, May 30, 2013 (PDF, 83 KB)), discussing scope of practice and education distinctions between AAs and Certified Registered Nurse Anesthetists (CRNAs). The transmittal makes clear that the –QZ modifier, indicating a non-medically directed anesthesia service, may only be reported for CRNA services.

All services should be provided in accordance with applicable state laws, and billing of such services should be done in accordance with payer guidelines. Medical direction of the AA should be documented by the physician, and in cases where medical direction guidelines are not fulfilled, the service may be billed as medically supervised (-AD modifier) on the part of the supervising physician with AA portion of the service reported with the medically directed anesthetist modifier (-QX).

This commentary is a summary prepared by McKesson’s Business Performance Services division and highlights certain changes, not all changes, in 2014 CPT® codes relating to the specialty of anesthesia and pain management. This commentary does not supplant the American Medical Association’s current listing of CPT® codes, its documentation in the annual CPT Changes publications, and other related publications from American Medical Association, which are the authoritative source for information about CPT® codes. Please refer to your 2014 CPT® Code Book, annual CPT® Changes publication, HCPCS Book and Payer Bulletins for additional information, including additions, deletions, changes and interpretations that may not be reflected in this document.

CPT is a registered trademark of the American Medical Association (“AMA”). The AMA is the owner of all copyright, trademark and other rights to CPT® and its updates. 


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McKesson Business Performance Services offers services and consulting to help hospitals, health systems, and physician practices improve business performance, boost margins and transition successfully to value-based care.