Modifiers · CPT modifier

Discontinued out-pt after anesthesia

Modifier 74 tells the payer that an outpatient or ASC procedure was started—or anesthesia was already given—but had to be stopped because of a medical emergency or a condition threatening patient safety. It is a facility-only modifier; the operating surgeon uses modifier 53 instead. Full fee-schedule reimbursement applies when 74 is appended correctly.

Verified May 8, 2026 · 11 sources ↓

Type: CPT
CPT codes use it: 96
Top regions: Foot & ankle, Other, Hip

Drawn from CMSNovitas SolutionsWPSPalmetto GBAAAPC

When to use modifier 74

Source · Editorial brief grounded in 11 cited references ↓

Append modifier 74 to the facility procedure code when all three conditions are met: (1) the patient was prepped and brought into the procedure room, (2) anesthesia—local, regional block, or general—had already been administered, and (3) the procedure was terminated because of extenuating clinical circumstances or a threat to patient well-being, not because the physician or patient elected to cancel. The trigger point distinguishing 74 from its companion modifier 73 is the moment anesthesia is given; once any anesthetic agent has been delivered and the surgeon has initiated the case (incision made, scope inserted, intubation started), modifier 74 is the correct choice.

Modifier 74 is exclusively a facility billing tool used by hospital outpatient departments and ASCs on institutional claim forms. Physicians and other qualified clinicians who need to report a discontinued procedure on a professional claim must use modifier 53—not 74. Mixing these up is one of the most common and consequential errors in outpatient coding.

Documentation must support the modifier. The operative report should state the specific reason for termination, describe what was actually performed, list supplies used, and record time spent in each phase (pre-op, intraoperative, post-op). CMS and commercial payers expect this level of detail before releasing payment. When anesthesia is not planned for the procedure at all, neither modifier 73 nor 74 applies; instead, a different reporting pathway is appropriate.

Orthopedic scenarios

Concrete situations in orthopedic practice that warrant modifier 74.

Source · Editorial brief grounded in AAOS coding guidance and cited references ↓

A patient is positioned and placed under general anesthesia for a total knee arthroplasty (TKA, CPT 27447) when intraoperative monitoring reveals new-onset ventricular arrhythmia. The surgeon halts the case before the incision is completed; the ASC appends modifier 74 to CPT 27447 and bills at 100% of the facility fee schedule.
During a shoulder arthroscopy (CPT 29821) performed under regional interscalene block, the patient develops severe bronchospasm after the scope is inserted. The procedure is immediately terminated; the ASC reports CPT 29821-74 with an operative note documenting the respiratory emergency, time in each phase, and supplies consumed.
A knee arthroscopy with partial medial meniscectomy (CPT 29881) is underway under spinal anesthesia when intraoperative imaging reveals an unexpected finding requiring open conversion that the ASC is not equipped to handle. The case is stopped; modifier 74 is appended to CPT 29881 on the facility claim.
A patient is under general anesthesia for open reduction and internal fixation (ORIF) of a distal radius fracture (CPT 25600 series) when a latex allergic reaction is identified and the procedure is aborted after the initial incision. The facility bills the ORIF code with modifier 74 at full ASC reimbursement.
An ACL reconstruction (CPT 27407) is initiated under general anesthesia; after graft harvesting begins, the patient's blood pressure drops precipitously. The surgeon discontinues the procedure. The ASC appends modifier 74 to CPT 27407, and the operative report details vital-sign trend, interventions, and time spent pre-op and intraoperatively.
A planned bilateral knee arthroscopy (CPT 29881-50) is abandoned after anesthesia induction and the scope is inserted into the first knee when a tourniqet-related complication arises. Because modifier 74 cannot be paired with modifier 50, the ASC bills the unilateral code CPT 29881-74 to reflect the partially initiated case.

Common mistakes

Where coders most often go wrong with modifier 74.

Source · Editorial brief grounded in CMS NCCI Policy Manual and cited references ↓

Appending modifier 74 on the surgeon's professional (CMS-1500) claim instead of reserving it for the ASC or hospital outpatient facility claim—surgeons must use modifier 53 for discontinued procedures.
Using modifier 74 when the procedure was electively cancelled at the patient's or physician's discretion before any clinical emergency arose; elective cancellations are not reportable with this modifier.
Reporting modifier 74 when anesthesia was never administered—if the procedure was stopped before any anesthetic agent was given, modifier 73 is correct and reimbursement drops to 50% of the fee schedule.
Combining modifier 74 with modifier 50 (bilateral procedure) on the same line; CMS and major payers prohibit this pairing. If a bilateral orthopedic procedure is discontinued before either side is completed, bill the unilateral code with modifier 74.
Appending modifier 74 to add-on CPT codes or unlisted procedure codes, both of which are excluded from valid usage per payer policy.
Failing to include a detailed operative report—missing documentation of the reason for termination, services rendered, and time in each surgical phase will result in denial even when the modifier is clinically justified.
Confusing the reimbursement rates: modifier 73 (pre-anesthesia) triggers 50% of the fee schedule; modifier 74 (post-anesthesia) triggers 100%—reversing these figures when counseling staff leads to revenue leakage or overpayment.
Reporting modifier 74 for a procedure terminated solely because of equipment failure or scheduling convenience rather than a patient safety or extenuating clinical circumstance.

CPT codes that use modifier 74

96 orthopedic CPT codes in our reference list this modifier as applicable. Sorted by total RVU.

Source · Derived from per-code modifier guidance in our CPT reference

Showing top 12 of 96 by total RVU.

Where modifier 74 shows up

Body regions where this modifier most commonly appears in our orthopedic reference.

Foot & ankle 22 codes
Other 18 codes
Hip 14 codes
Knee 11 codes

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 11 cited references ↓

01What is the difference between modifier 74 and modifier 73?

The dividing line is anesthesia administration. Modifier 73 applies when the procedure is discontinued before any anesthetic agent is given; modifier 74 applies once anesthesia has been administered. Reimbursement also differs: modifier 73 yields 50% of the ASC fee schedule, while modifier 74 yields 100%.

02Can the operating surgeon bill modifier 74 on a professional claim?

No. Modifier 74 is strictly a facility modifier used by ASCs and hospital outpatient departments on institutional claims. Surgeons and other qualified clinicians reporting a discontinued procedure on a professional (CMS-1500 or 837P) claim must use modifier 53 instead.

03What reimbursement rate applies when modifier 74 is used correctly?

CMS and most commercial payers reimburse the ASC at 100% of the applicable facility fee schedule rate when modifier 74 is correctly appended, reflecting the near-complete resource expenditure that occurs once anesthesia is induced and the procedure begins.

04Does modifier 74 apply to elective cancellations?

No. Modifier 74 is reserved for discontinuation due to extenuating circumstances or conditions threatening patient well-being. If the physician or patient elects to cancel the procedure—even after the patient has entered the OR—modifier 74 is not reportable.

05What documentation must accompany a claim billed with modifier 74?

The operative report must include: the specific clinical reason for termination, a description of services actually performed and supplies used, a list of services and supplies that would have been provided had the procedure continued, and time spent in each phase (pre-op, intraoperative, post-op). Missing any of these elements is a leading cause of modifier 74 denials.

06Can modifier 74 be used together with modifier 50 for a bilateral orthopedic procedure?

No. Modifier 74 and modifier 50 cannot be combined on the same claim line. If a bilateral procedure (e.g., bilateral knee arthroscopy) is discontinued after anesthesia, bill the unilateral procedure code with modifier 74 only. If one side was completed before the case was stopped, bill the completed side at full rate and the incomplete side with modifier 74.

07Is modifier 74 valid on add-on codes or unlisted procedure codes?

No. Payer policies, including Premera and Johns Hopkins Health Plans, explicitly exclude modifier 74 from add-on CPT codes and unlisted procedure codes. Append modifier 74 only to primary procedure codes for which anesthesia was planned and administered.

08Who may use modifier 74 in a hospital outpatient department (HOPD) setting?

Modifier 74 is appropriate for hospital outpatient department (HOPD) facility billing in addition to ASC billing, as long as the same clinical criteria are met: anesthesia was administered, the procedure was initiated, and termination resulted from a clinical emergency or patient safety concern—not an elective decision.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

01CMS Medicare Claims Processing Manual, Pub. 100-04, Chapter 4, §20.6.4 — https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c04.pdf
02CMS Medicare Claims Processing Manual, Pub. 100-04, Chapter 14, §40.4
03Novitas Solutions Modifier 74 Fact Sheet (Medicare JL) — https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00144541
04WPS Government Health & Human Services Modifier 74 Fact Sheet — https://www.wpsgha.com/guides-resources/view/115
05Palmetto GBA Jurisdiction J Part B CPT Modifier 74 — https://dominoapps.palmettogba.com/palmetto/jjb.nsf/DIDC/8EELFF6250~Claims~Modifier%20Lookup
06AAPC Knowledge Center: Facility Coding for Modifiers 52, 73, and 74 — https://www.aapc.com/blog/90202-facility-coding-for-modifiers-52-73-and-74/
07HIA Code Blog: Use of CPT Modifiers 53, 73, and 74 for Discontinued Procedures — https://hiacode.com/blog/use-of-modifiers-53-73-74-discontinued-procedures
08Johns Hopkins Health Plans Reimbursement Policy RPC.019: Discontinued Procedures (Modifiers 73 and 74), v2.0, effective 06/10/2024 — https://www.hopkinsmedicine.org/-/media/johns-hopkins-health-plans/documents/policies/rpc019-discontinued-procedures.pdf
09Premera Blue Cross Payment Policy CP.PP.146.v3.0: Modifier 74—Discontinued Outpatient Hospital/ASC Procedure after Administration of Anesthesia — https://www.premera.com/portals/provider/paymentpolicies/cmi_051767.pdf
10Moda Health Reimbursement Policy RPM049: Modifiers 73 & 74—Discontinued Procedures for Facilities — https://www.modahealth.com/idaho/-/media/modahealth/shared/Provider/Policies/RPM049-Discontinued-Procedures-For-Facilities.pdf
11AMA CPT Assistant: Coding Consultation guidance on modifiers for discontinued procedures (AMA Press)

Mira AI Scribe

MODIFIER 74 TRIGGER — If your operative note documents that (a) the patient entered the procedure room, (b) anesthesia (local, regional, or general) was administered, and (c) the case was stopped before completion due to a medical emergency or patient safety concern, flag the note for ASC facility coder review for modifier 74. Key phrases to capture: anesthesia type and time of administration, specific clinical reason for termination, incision/scope/intubation status at time of stoppage, and time spent in pre-op, operative, and post-op phases. Do NOT flag if the cancellation was elective, if anesthesia was never given (flag for modifier 73 review instead), or if the note is for a physician professional fee claim (flag for modifier 53 review). Modifier 74 is facility-only and triggers full fee-schedule reimbursement.

See how Mira flags modifier 74 in dictation