Modifier QY- Medical Direction of One CRNA

Identifies anesthesia services in which an anesthesiologist provides medical direction for one certified registered nurse anesthetist during an anesthesia procedure.

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What Is Modifier QY?

Modifier QY is used when an anesthesiologist medically directs one Certified Registered Nurse Anesthetist (CRNA) during an anesthesia service.

The modifier identifies the anesthesiologist's medical-direction portion of the anesthesia service. CMS currently specifies that QY is used by the supervising physician.

When an anesthesiologist and a medically directed CRNA participate in a single anesthesia case, the anesthesiologist reports Modifier QY, while the CRNA generally reports Modifier QX.

Under Medicare's medical-direction payment rules, each provider's portion of a qualifying QY/QX case is generally paid at 50% of the allowance that would otherwise be recognized if the anesthesiologist personally performed the anesthesia service alone.

When to Use Modifier QY

One CRNA Is Medically Directed: The anesthesiologist provides qualifying medical direction for one CRNA during the anesthesia case.

Anesthesiologist's Claim: QY identifies the anesthesiologist's medical-direction service.

Medical Direction Requirements Are Met: The anesthesiologist satisfies Medicare requirements necessary to qualify the service as medical direction.

CRNA Participates in the Case: A CRNA provides the anesthesia service under the anesthesiologist's medical direction.

Anesthesia Service Is Documented: The anesthesia record supports the involvement and responsibilities of both providers.

When NOT to Use Modifier QY

Anesthesiologist Personally Performs the Service: Modifier AA generally identifies anesthesia personally performed by the anesthesiologist.

Two to Four Concurrent Cases: Modifier QK generally applies when an anesthesiologist medically directs two, three, or four concurrent anesthesia procedures involving qualified individuals.

CRNA's Portion of the Service: The medically directed CRNA generally reports Modifier QX rather than QY.

CRNA Without Medical Direction: Modifier QZ identifies a CRNA service furnished without physician medical direction.

Medical Direction Requirements Not Met: Do not report QY merely because an anesthesiologist was present or available. The circumstances must satisfy applicable medical-direction requirements.

Billing Example

A patient undergoes surgery requiring anesthesia.

A CRNA furnishes the anesthesia service while an anesthesiologist provides qualifying medical direction for that single CRNA.

The anesthesiologist reports the appropriate anesthesia code with Modifier QY.

The CRNA reports the corresponding anesthesia service with Modifier QX.

This QY/QX combination identifies the respective portions of a single medically directed anesthesia case. CMS continues to recognize QY and QX for this billing arrangement.

Documentation Requirements

Medical Direction: Documentation should establish that the anesthesiologist provided qualifying medical direction.

Anesthesia Record: Maintain a complete record of the anesthesia service and the providers involved.

Provider Participation: Clearly identify the anesthesiologist and CRNA participating in the case.

Anesthesia Time: Accurately document anesthesia start and stop times according to applicable Medicare requirements.

Required Medical-Direction Activities: Documentation should support the anesthesiologist's performance of the activities required for medical direction.

Medical Necessity: The record should support the medical necessity of the anesthesia service and underlying procedure.

Billing and Claim Considerations

Modifier QY is an anesthesia payment modifier, not simply an informational modifier.

CMS currently defines QY as medical direction of one CRNA by an anesthesiologist and notes that it is used by the supervising physician.

The CRNA's corresponding medically directed service is generally reported with Modifier QX. This makes QY and QX closely related but they should not be confused: QY represents the anesthesiologist's medical direction, while QX represents the CRNA's service under medical direction.

Medicare anesthesia payment also depends on applicable base units, anesthesia time, the anesthesia conversion factor, and the payment modifier reported. CMS maintains separate 2026 anesthesia conversion-factor information for these calculations.

Common Billing Mistakes

Reporting QY for the CRNA: QY identifies the anesthesiologist's medical-direction service; the medically directed CRNA generally reports QX.

Using QY for Multiple Concurrent Cases: Medical direction of two to four concurrent qualifying anesthesia procedures is generally reported with QK rather than QY.

Confusing QY With AA: AA represents anesthesia personally performed by the anesthesiologist rather than medical direction of another anesthesia professional.

Using QY Without Medical Direction: The anesthesiologist's participation must satisfy applicable medical-direction requirements.

Missing Anesthesia Time: Incomplete or inaccurate anesthesia time can affect Medicare anesthesia payment.

Incomplete Documentation: The record does not adequately support the anesthesiologist's medical-direction role.

Common Denial Reasons

Medical Direction Not Supported: Documentation fails to demonstrate qualifying medical direction.

Incorrect Anesthesia Modifier: The circumstances support AA, QK, or another anesthesia modifier instead of QY.

Provider Role Conflict: Claim information does not support the reported relationship between the anesthesiologist and CRNA.

Missing or Incorrect Anesthesia Time: Required anesthesia time information is incomplete or inconsistent.

Duplicate or Conflicting Claims: The physician and CRNA claims contain information that does not accurately reflect the same anesthesia case.

Medical Necessity Not Supported: Documentation does not support the anesthesia service billed.

Modifier QY vs. Modifier QX

Modifier QY: Identifies the anesthesiologist's medical direction of one CRNA.

Modifier QX: Identifies the CRNA's anesthesia service furnished with physician medical direction.

When an anesthesiologist medically directs one CRNA during the same anesthesia case, QY is generally reported for the anesthesiologist and QX for the CRNA.

Modifier QY vs. Modifier QK

Modifier QY: Medical direction of one CRNA by an anesthesiologist.

Modifier QK: Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals.

The primary distinction is the number of anesthesia procedures being medically directed concurrently.

Frequently Asked Questions

Who reports Modifier QY?
The anesthesiologist providing medical direction reports QY. CMS's current guidance specifically identifies QY as a modifier used by the supervising physician.

What modifier does the CRNA report when the anesthesiologist reports QY?
The medically directed CRNA generally reports Modifier QX for the corresponding anesthesia service.