Please be advised, consistent with original Medicare and Texas Medicaid which do not recognize Physical Status Modifiers P1 – P6, Community First Health Plans, Inc. (Community First) will no longer allow additional reimbursement for physical status modifiers P3-P6. This change will be effective for dates of service beginning on August 1, 2023.
Community First will continue to reimburse Commercial HMO and Community First Insurance Plans providers (Marketplace).
Modifiers must be appended to CPT codes 00100 through 01999 as outlined below. The submission of a physical status modifier appended to an anesthesia procedure code indicates that documentation is available in the patient’s records supporting the situation described by the modifier descriptor. Appending these modifiers to any other codes not described above will be denied for improper use of modifier.
The additional reimbursement is equivalent to additional anesthesia time at the fee schedule rate:
P3=1 RVU
P4=2 RVU
P5=3 RVU
Please contact Provider Relations at 210-358-6294 if you have additional questions.
Helpful Resources:
https://www.asahq.org/quality-and-practice-management/managing-your-practice/timely-topics-in-payment-and-practice-management/anesthesia-payment-basics-series-4-physical-statushttps://med.noridianmedicare.com/web/jeb/topics/modifiers