What QZ means
QZ is the Medicare modifier for a CRNA service without medical direction by a physician. It applies whether the CRNA worked alone or with a physician who did not meet the medical direction requirements.
When to use it
- A CRNA provides the anesthesia and no anesthesiologist medically directs the case
- An anesthesiologist was involved but did not meet all medical direction requirements for that case
- The surgeon or proceduralist supervises, which is not the same as anesthesiologist medical direction
How it is paid
With QZ, the CRNA can be paid the full anesthesia fee. Compare QX, used when the CRNA is medically directed, where Medicare generally pays the CRNA about half and the directing anesthesiologist the other half.
Common mistakes
- Using QX when the anesthesiologist's documentation does not support medical direction
- Using QZ when an anesthesiologist did medically direct the case, which can lead to overpayment and recovery
- Assuming commercial payers follow Medicare's modifier rules; many have their own
See also: all CRNA billing modifiers and the seven medical direction requirements.
This article is general information, not billing, legal or tax advice. Payer rules change; always check current guidance.