The Body Mass Index (BMI) modifier may be claimed for selected procedures, obstetrical services, anesthesia, second qualified surgeon and surgical assistant services provided in any location when the following criteria are met:
BMI modifiers (BMIPRO, BMISRG, BMIANT, BMIANE) should be added to all HSCs that are claimed at the same encounter for patients that have a BMI of 40 or greater.
The change to the BMI criteria to make it BMI of 40 affects the adult population ONLY. There HAVE NOT been any changes to the pediatric criteria for BMI. Physicians MAY NOT round a patients BMI up to 40 in order to claim the higher fee, the patients BMI must actually be 40 or greater at the time of the service.
BMI of 40 applies to all procedures and services that carry the BMI modifier.
Even though there isn't a BMI modifier on the complex care plan (03.04J) for General Practitioners, the BMI of 40 is used as the definition of obesity for adults.
It is not acceptable to round the patients BMI up to 40 in order to claim the higher fee. The patients BMI MUST be 40 or greater.
