February 12, 2026, Update: For further clarification on the article below previously published on February 2, 2026, conflicts in the reporting of personally performed, medical direction, and medical supervision modifiers by the same member on the same day may result in claim denial(s). Additionally, it is not appropriate to bill multiple anesthesia modifiers on the same claim line, as they are considered mutually exclusive with exception of Modifier QS. Blue Cross NC is making this change to ensure accurate coding and reimbursement for anesthesia involvement provided during the service. 

February 2, 2026, Update: The Anesthesia Modifiers Reimbursement Policy update is effective April 3, 2026. This policy update was originally published February 1, 2026.

Effective April 3, 2026, billing multiple anesthesia modifiers on the same date of service is not appropriate, as these modifiers are considered mutually exclusive, with the exception of modifier QS.

This is an update to our Anesthesia Services, Professional and Facility reimbursement policy.

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) requires the appropriate use of anesthesia modifiers to accurately identify the individual who performed the anesthesia service and their level of involvement (personally performed, medically directed, or medically supervised). Modifiers indicating who performed the service must be submitted in the first modifier position, followed by the applicable physical status modifiers.

Please see the related policy notification for more information.

This policy applies to commercial, Inter-Plan Program (IPP) Host, and Federal Employee Program (FEP). This does not apply to Medicare Advantage or IPP Home.