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Wiki Modifiers QK, QY, QX, QZ

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Modifiers QK, QY, QX, QZ

Modifiers are reported to identify anesthesia provider(s) involved in the case. In many instances, there are multiple providers involved with anesthesia cases. HCPCS Level II modifiers for anesthesia providers include:

• QK Qualified Individual who is medically directing two to four concurrent procedures

• QY An anesthesiologist that medically directed a CRNA in a single case

• QX A medically directed CRNA

• QZ CRNA who is performing anesthesia services without medical direction by a physician

In some cases, more than one provider delivers anesthesia services. For example, an anesthesiologist performs medical direction for a CRNA. The anesthesiologist reports the anesthesia code with modifier QK if he is medically directing two to four concurrent cases. The CRNA reports the same anesthesia code with modifier QX. For the CRNA’s claim, it is not necessary to know exactly how many anesthesia cases the anesthesiologist is medically directing. We need to know the CRNA is being medically directed. To determine the correct modifier for the anesthesiologist, the numbers of concurrent cases being directed must be known.

There are seven elements that are required by Medicare to report medical direction. The elements include: Performs pre-anesthetic exam and evaluation; prescribes the anesthesia plan; personally participates in the most demanding procedures in the anesthesia plan; ensures any procedures that are not personally performed are performed by a qualified individual (AA, CRNA, residents); monitors the course of anesthesia in frequent intervals; remains physically present and available for emergencies; and provides indicated postoperative care.


Charlotte, NC
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Modifers QK,QY,QX,QZ

Can someone shed some light on how these modifiers are used? I find that CPT does a good job of explaining modifiers but when it comes to HCPCS I find that in some cases I need a little more info. If you are using these and can shed some light as to their use I would appreciate it.
Last edited:
Woodbridge, VA
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You will find some useful information on trailblazerhealth.com. If you do a search for Modifiers Manual, you'll find one was recently published April 2008. This defines the modifers you are asking about. If you do another search for Anesthesia Services, you will find examples of how to use the modifiers in question. I hope this helps.

Zaida, CPC
Northern Virginia Urology


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These are anesthesia modifier for the MDA(QK/QY) and the CRNA(QX/QZ).

The Q modifiers for the MDA are used when they are medically directing a CRNA(s). Use the QK when the MDA is medically directing 2-4 concurrent anesthesia cases. The QY is used when the MDA is medically directing 1 CRNA.

The QX and QZ are used for the CRNA. Use a QX when a billing for a CRNA that is being medically directed by an MDA. The QZ is used when the CRNA provides anesthesia without an MDA present(no medical direction).

Hope this helps!


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Modifiers, QK, QY, QX, QZ

What is the correct way to code for a CRNA who is medically supervised when the anesthesiologist submits a claim using the -AD modifier? I'm having quite a bit of difficulty finding anything that differentiates between medical supervision and medical direction since the CRNA modifiers do not state supervision.

Any assistance would be greatly appreciated.



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When -AD is reported for the physician, use QX for the CRNA. There is no other modifier for a supervised CRNA.

Hope that helps.

Steve Young, CPC
Frederick, MD