AI: Principal physician of record modifier
For Medicare only
The AI modifier represents the physician who provides an initial visit to a member during an inpatient stay. Physicians reporting modifier “AI” will identify themselves as the physician who will oversee the member’s care from all other physicians furnishing specialty care. Priority Health will align with the CMS guidance.
When to use modifier AI:
- Admitting physician appends to the initial inpatient hospital care evaluation and management service (99221-99223)
- Append after payment modifiers
- Claim may deny when modifier "AI" is not used
- AI modifier
- Anatomic modifiers
- Anesthesia modifiers
- AT: Active treatment
- FT: Unrelated critical care services
- GA, GY and GZ: Medicare non-coverage notification
- GN, GO & GP: Therapy type
- JW, JZ modifiers
- UD and UA: Treated and released or admitted/transferred (Medicaid only)
- 59, XE, XS, XP, XU: Distinct services
- 22: Unusual procedural services
- 25: Significant service separate from E&M service
- 26 and TC: Professional and technical components
- 27: Multiple E/M services in hospital outpatient departments
- 33: Preventive service
- 50 & 51: Bilateral and multiple procedures
- 52: Reduced services
- 53: Discontinued procedure
- 54 & 55: Surgical care and post-op care
- 56: Pre-operative management only
- 57: E&M service same day or before major surgery
- 62: Two surgeons
- 73 & 74: Discontinued outpatient surgery
- 76 & 77: Repeated procedures, same day
- 78: Unplanned return to operating room
- 80, 81, 82: Assistant at surgery