In Healthcare Common Procedure Coding System (HCPCS) Level II coding, two alphanumeric characters placed after the usual five-digit CPT procedure code number. These modifiers are used to identify specific anatomical parts of the body when the CPT procedure code does not include that information. HCPCS modifiers are accepted by insurance carriers nationally and are updated annually by the Centers for Medicare and Medicaid Services (CMS).

Large medical group composed of multispecialists with multidisciplines that under managed care contracts handle the bulk of treatments and referrals of member patients and carry most of the clinical risk. Also called key groups or core groups.

Supplemental health care service required as part of giving other care such as anesthesia, laboratory, pharmacy, and radiology; other than routine hospital services (room, board, medical and nursing services).

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Fees charged for additional services (other than room and board charges), such as x-rays, anesthesia, lab work, etc. The term may also be used to describe the charge made by a pharmacy for prescriptions which exceed the health insurance policy’s maximum allowable cost.

Fee for an ancillary service that is sometimes billed as an additional service such as anesthesia, laboratory, pharmacy, or radiology charge and which may exceed the managed care plan’s maximum allowable.

Medical professional with a limited license to practice medicine and therapy who may bill for these services. See also nurse practitioner (NP), physician extender (PE), and physician assistant (PA).

1. Supportive professional services other than room, board, and routine hospital services that are incidental to the hospital stay and provided by the facility such as ambulance, anesthesia, blood administration, drugs, laboratory tests, pharmacy, operating room, x-rays, medical, surgical, and central supplies; physical, occupational, and speech therapy; and inhalation therapies. Also called inpatient ancillary services. 2. In a medical office setting, ancillary medical services may consist of diagnostic tests such as x-rays or laboratory tests.

Payment formula is performed by taking the base anesthesia procedure units and adding them to the time reported, as well as units for physical status modifiers, qualifying circumstances, and any other allowed units or charges. This sum is multiplied by a conversion factor.

Division of the Current Procedural Terminology (CPT) code book that contains information about anesthesia services.