CPT Modifier 74

Published 04/05/2023

Description
Discontinued out-patient hospital/ambulatory surgical center (ASC) procedure after the administration of anesthesia.

Guidelines and Instructions
  • Submit CPT modifier 74 for ambulatory surgery center (ASC) facility charges when the surgical procedure is discontinued after anesthesia is administered
  • This modifier may not be submitted by the operating surgeon. Only ASCs should submit this modifier. Surgeons may refer to CPT modifier 53.
  • ASC claims that involve a terminated surgery must be accompanied by an operative report. The operative report should include the following:
    • Reason for termination of surgery
    • Description of services actually performed
    • Description of supplies actually provided
    • Services not performed that would have been if surgery had not been terminated
    • Supplies that would have been provided if the surgery had not been terminated
    • Time actually spent in each stage (e.g., pre-op, operative and post-op)
    • Time that would have been spent in each of these stages if the surgery had not been terminated 
  • Surgical procedures scheduled to be performed in an ASC that are terminated are subject to specific reimbursement:
    • Procedure terminated before administration of anesthesia — 50 percent of fee schedule
    • Procedure terminated after administration of anesthesia — 100 percent of fee schedule
  • Procedures terminated before the ASC has expended substantial resources will not be covered
  • If intraocular lens (IOL) insertion is terminated, the allowance for the unused IOL will be deducted prior to payment
Reference: Internet Only Manual (IOM), Publication 100-04, Chapter 14 (PDF).

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