These modifiers indicate a procedure in an outpatient hospital/ambulatory surgery center (ASC) setting that was cancelled after the patient's surgical preparation.

 

Modifier 73

Modifier 73 indicates the cancellation happened before the administration of anesthesia.

Acceptable reasons for cancellation

Due to extenuating circumstances or a threat to patient well-being:

• Prior to procedure started/patient's surgical preparation (including sedation or taken to procedure room)
• Prior to administration of anesthesia (local, regional block or general)

Do not use when

• Physician cancelled the surgical or diagnostic procedure prior to administration of anesthesia and/or surgical preparation of the patient
• Cancellation of a procedure is elective
• Surgeon cancels or postpones because patient complained of a cold or flu upon intake

Modifier 74

Modifier 74 indicates the cancellation happened after the administration of anesthesia and/or the initiation of the procedure. Priority Health may request notes to determine the extent of services rendered.

For physician reporting of a discontinued procedure, see modifier 53.

Reference the CPT Manual for additional instruction.

Acceptable reasons for cancellation

Cancellation must be due to extenuating circumstances, or those that threaten the life of the patient.

• Physician may terminate surgical/diagnostic procedure
• After procedure started (incision made, intubation started, scope inserted)
• After administration of anesthesia (local, regional block or general)

Under these circumstances, intended service is prepared, but canceled and billed with usual procedure number

Don't use these modifiers, to report an elective cancellation of the procedure. Don't report elective cancellation of patient service prior to administration of anesthesia and/or surgical preparation.

Reimbursement

Reimbursement for Modifier 73 for all products will be 50% of the base fee schedule. There will be no reduction to reimbursement for Modifier 74.