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