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    Modifier: BMI

    BMI

    This modifier is used to support the additional payment of 25% for selected procedures, obstetrical services, anesthesia, second qualified surgeon and surgical assistant services for adult patients who meet requirements indicated in the Governing Rules and patients under 18 years of age who are above the 97th percentile for BMI on an approved pediatric growth curve.

    AMA billing tips:

    • 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.

    Codes:

    Code:Description:
    BMIABD
    Body Mass Index, ANESTHETIC BY DEFINITION
    Explicit

    The physician functions as the Anesthetist and is claiming a Health Service Code (HSC) which is an anesthetic by definition and does not have modifier ANE.

    Please refer to Governing Rule 18.1 for more information.

    BMIANE
    Body Mass Index, ANESTHETIST
    Explicit

    The physician functions as the Anesthetist and is claiming the listed anesthetic benefit.

    Please refer to Governing Rule 18.1 for more information.

    BMIANT
    Body Mass Index, ANESTHETIST TRC
    Explicit

    The physician functions as the Anesthetist and is claiming a benefit based on the duration of the anesthetic.

    Please refer to Governing Rule 18.1 for more information.

    BMIPRO
    Body Mass Index, SURGEON/SECOND QUALIFIED SURGEON/SURGICAL ASSISTANT
    Explicit

    The physician functions as the Surgeon, Second Qualified Surgeon, or as a Surgical Assistant and is claiming the listed applicable benefit.

    BMISRG
    Body Mass Index, SURGEON/SECOND QUALIFIED SURGEON/SURGICAL ASSISTANT
    Explicit

    The oral maxillofacial surgeon functions as the Surgeon, Second Qualified Surgeon, or as a Surgical Assistant and is claiming the listed applicable benefit. This modifier may only be claimed by oral maxillofacial surgeons.

    Please refer to Governing Rule 18.1 for more information.

    BMI2AN
    Body Mass Index, ANESTHETIST TRC 2
    Explicit

    The physician functions as the anesthetist and is claiming anesthetic time premium units based on the duration of the anesthetic.

    Please refer to Governing Rule 18.1 for more information.