I. Description
Modifier code 47 represents anesthesia by surgeon. The modifier should only be used to represent general anesthesia or a regional block. It should not be used to represent local anesthesia by the surgeon. Local anesthesia is included in the global fee for the surgery and should not be billed separately.
HMSA will allow additional payment for anesthesia by surgeon for selected procedures only. Most of the procedures for which additional payment is allowed involve the female reproductive system. (Refer to list below.) No additional allowance is made for anesthesia by surgeon for surgeries other than those listed.
Example 1 - modifier 47 appropriate
The surgeon will be performing an endometrial biopsy. Prior to surgery, he initiates a regional block. The surgeon may bill using the CPT code for the biopsy, followed by modifier 47.
Example 2 - modifier 47 not appropriate
The physician injects lidocaine into surrounding tissue prior to repairing a superficial laceration to the patient's index finger.
II. Claims filing instructions
Claims for anesthesia by surgeon should be submitted using two lines. On the first line enter the surgical procedure code. On the second line list the surgical procedure code followed by modifier 47.
For example 1 above, the claim would be completed as follows:
| Line | CPT Code | Modifier Code |
|---|---|---|
| 1 | 58100 | -- |
| 2 | 58100 | 47 |
III. Applicable procedure codes
| CPT Code | Description |
|---|---|
| 42106 | Excision, lesion of palate, uvula; with simple primary closure |
| 42825 | Tonsillectomy, primary or secondary; under age 12 |
| 42826 | age 12 or over |
| 57020 | Colpocentesis (separate procedure) |
| 57452 | Colposcopy of the cervix including upper/adjacent vagina; |
| 57454 | with biopsy of the cervix and endocervical curettage |
| 57460 | with loop electrode biospy(s) of the cervix |
| 57500 | Biopsy, single or multiple, or local excision of lesion, with or without fulguration (separate procedure) |
| 57505 | Endocervical curettage (not done as part of a dilation and curettage) |
| 57513 | Cautery of cervix; laser ablation |
| 57520 | Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser |
| 57522 | loop electrode excision |
| 57800 | Dilation of cervical canal, instrumental (separate procedure) |
| 58100 | Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure) |
| 58120 | Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical) |
| 58563 | Hysteroscopy, surgical; with endometrial ablation (e.g., endometrial resection, electrosurgical ablation, thermoablation) |
| 59160 | Curettage, postpartum |
| 59200 | Insertion of cervical dilator (e.g., laminaria, prostoglandin) (separate procedure) |
| 59400 | Routine obstetric care including antepartum care, vaginal delivery (with or without episotomy and/or forceps) and postpartum care |
| 59409 | Vaginal delivery only (with or without episiotomy and/or forceps); |
| 59410 | including postpartum care |
| 59610 | Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy and/or forceps) and postpartum care, after previous cesarean delivery |
| 59612 | Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); |
| 59614 | including postpartum care |
| 59812 | Treatment of incomplete abortion, any trimester, completed surgically |
| 59820 | Treatment of missed abortion, completed surgically; first trimester |
| 59821 | second trimester |
| 59830 | Treatment of septic abortion, completed surgically |
| 59840 | Induced abortion, by dilation and curettage |
| 59841 | Induced abortion, by dilation and evacuation |
| 59850 | Induced abortion, by one or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines; |
| 59851 | with dilation and curettage and/or evacuation |
| 59852 | with hysterotomy (failed intra-amniotic injection) |
| 64721 | Neuroplasty and/or transposition; median nerve at carpal tunnel |
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |