Wiki CMS Policy for P1-P6

[Anduiza05]

Does anyone know where I can find the policy on the CMS website stating that providers should not submit P1-P6 on their claims?

 

[bkeeling]

CMS modifiers P1-P6

If you look to your individual MAC carrier they should have a section for anesthesia billing, for example this is found in WPS:
Anesthesia Physical Status Modifier Fact Sheet
Definition
P1 - A normal healthy patient
P2 - A patient with mild systemic disease
P3 - A patient with severe systemic disease
P4 - A patient with severe systemic disease that is a constant threat to life
P5 - A moribund patient who is not expected to survive without the operation
P6 - A declared brain-dead patient whose organs are being removed for donor purposes
Appropriate Usage
Append to anesthesia service/procedure codes
The modifiers are informational only and do not affect payment
Inappropriate Usage
Appending this modifier to CPT codes other than 00100 through 01999 - Anesthesia Codes
Appending the modifier for a situation other than the one described by the descriptor


as you can see it is considered inappropriate to use with anesthesia codes. Hope this helps...

 

[CodingKing]

as you can see it is considered inappropriate to use with anesthesia codes. Hope this helps...

The inappropriate use comment refers to the last 2 lines

Appending this modifier to CPT codes other than 00100 through 01999 - Anesthesia Codes
Appending the modifier for a situation other than the one described by the descriptor

They may not be required for all payers, nor give additional reimbursement by post payers but there is nothing wrong when using them when not required