Claiming the BMI modifier for procedures

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:

1. An adult patient has a body mass index of 40 or more.

2. A patient under 18 years of age who is above the 97th percentile for BMI on an approved pediatric growth curve.

To find out whether or not a procedure has a BMIPRO modifier, you may consult Price List of the Schedule of Medical Benefits.

Use the Ctrl+F to open up the search bar and enter in the fee code and review the Price List.

You may also try the AMA Fee Navigator®:

Type the fee code into the search bar and review the Price List.

Procedures that were previously listed as having BMISRG may still be submitted for additional payment using the BMIPRO modifier.

Anesthetic services should be submitted using the BMIANT, BMIANE as appropriate for eligible services provided in any location (local anesthetic excluded).

Additional information

  • The following HSCs are only eligible for the BMI modifier when the service is provided under general, spinal, epidural anaesthetic or regional nerve block performed in an operating room, day surgery or surgical suite: 98.11A, 98.11B, 98.11C, 98.11D, 98.11E, 98.11F, 98.22A, 98.22B

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