BMI, Body Mass Indicator

Criteria:

The BMIPRO modifier is billable for eligible services provided in any location (including the physician’s office) when the patient has met the criteria for BMI:

  • An adult patient has a body mass index of 40 or more.
  • A patient under 18 years of age who is above the 97th percentile for BMI on an approved pediatric growth curve.

The BMI modifier increases the payment of a procedure(s) by 25% when applied to specific procedures, consult the Medical Price Benefits List or the AMA Fee Navigator® to see which HSCs have the BMI modifier listed.

  • The modifier can be applied to all services provided by the surgeon, surgical assistant or anesthesiologist at the same encounter

Access the Medical Price Benefits List

 

Additional information:

Make sure to apply the BMI modifier correctly on all of the applicable claims that are submitted for the patient. Some physicians are only entering “BMI” into the modifier field. This is not a valid modifier and will not result in payment of the additional 25%.

The correct modifier to enter into the modifier field for the role of the surgeon is BMIPRO. Surgical assist requires two modifiers: SA into one field and BMIPRO into another field.

The appropriate BMI modifiers for anesthesia are as follows (choose one as appropriate):

  • BMIANE — Anesthetic services claimed by procedure.
  • BMIANT — Anesthetic services claimed by time (ANEST).
  • BMI2AN — Anesthetic services claimed by 2ANES.
  • BMIABD — the physician functions as the anesthetist and is claiming a Health Service Code (HSC), which is an anesthetic by definition and does not have the modifier ANE (epidural or dental anesthetic).

Governing rules

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