Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Modifiers)
MOD Description Submission Guidelines Impact to Payment
-90 Reference
(outside) Lab
-91 Repeat Clinical
Diagnostic Lab
Test
-99 Multiple
Modifiers
-AA Anesthesia
services
performed
personally by
anesthesiologist
-AD Medical
supervision by a
physician; more
than four
concurrent
anesthesia
procedures
-AS PA, Nurse
Practitioner, or
Clinical Nurse
Specialist
Services for
Assistant at
Surgery
11-12
The use of the –90 modifier is appropriate
when a lab provider, not the treating
physician, performs a laboratory
procedure. The –90 modifier should be
appended to the procedure code/test that
was sent to the lab.
Append the modifier to a lab procedure
that was repeated during the day.
Modifier -99 indicates that multiple
modifiers may apply to a particular service.
Because Blue Cross can accept up to four
modifiers, -99 should be used only if there
are five or more modifiers applicable to a
particular service line. In that
circumstance, if -99 is submitted, the
additional modifiers must be entered on the
narrative record.
Append the modifier when the
anesthesiologist is physically present in the
operating room, personally performs the
induction and emergence, and directly
monitors the patient throughout the entire
operative procedure.
Append the modifier when the
anesthesiologist supervises more than four
concurrent anesthesia procedures. The
anesthesiologist may perform the induction
and emergence but may not be present
during the entire operative session.
Append this modifier to surgical assists
performed by a physician assistant, nurse
practitioner, or clinical nurse specialist.
The modifier does not
impact payment for
the lab test; however,
it may be used in
determining whether
payment will be made
for more than one
type of specimen
collection.
Separate payment of
the service may be
made.
Impact of payment or
adjudication may be
based on what the
additional modifier(s)
represents.
Payment is made at
the full-time
anesthesia conversion
rate.
Payment is made at
the part-time
anesthesia conversion
rate.
Payment is made at
16% of the allowed
amount.
Multiple surgery
pricing logic also
applies to assistant as
surgery services.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (10/05/11)