Modifier -74 (Facility): Discontinued Outpatient/ASC Procedure After Administration of Anesthesia

Quick reference

What it signals: Append -74 to a surgical or diagnostic procedure code to indicate the procedure was discontinued after anesthesia was administered (or after the procedure was started — incision made, intubation started, etc.) due to extenuating circumstances or a threat to patient well-being.
Facility use only: This is a facility-side modifier for outpatient hospital and ASC claims. It is not used by the performing physician/surgeon (use -53 on the professional side instead).
Key distinction from -73: -73 = discontinued before anesthesia was given; -74 = discontinued after anesthesia was given or after the procedure was initiated.

Reduced payment does NOT apply: Unlike -52 (reduced services), CMS does not reduce reimbursement for procedure codes billed with -74. The full ASC/outpatient facility payment is generally recognized because anesthesia was already induced or the procedure was started.
Use only at the facility level: Append -74 to the ASC or outpatient facility surgical procedure code — not the anesthesia code itself. The anesthesia code is reported separately by the anesthesia provider.
Extenuating circumstances required: Documentation must support that the discontinuation was due to circumstances beyond routine — a change in patient condition, life-threatening event, or other clinical necessity. Elective patient refusal after induction is a common scenario.
Do not use for radiology: Discontinued radiology/diagnostic procedures that do not require anesthesia use -52 instead of -74.

Reason for discontinuation clearly documented: The operative/procedure note must state why the procedure was stopped post-anesthesia (e.g., cardiac event, respiratory instability, change in VS, unexpected finding upon incision).
Point of termination noted: Document exactly where in the procedure the termination occurred (pre-incision but post-induction, mid-procedure, etc.) to support -74 vs -73.
Anesthesia administration confirmed: The anesthesia record must show that anesthesia was induced prior to termination.
Separate anesthesia claim: Anesthesia services should be billed on a separate line/claim by the anesthesia provider using the appropriate anesthesia code with time units.

Patient undergoes general anesthesia for a laparoscopic cholecystectomy; upon incision, the surgeon identifies unexpected adhesions and discontinues — bill the procedure code with -74.
Patient is intubated for a flexible bronchoscopy; desaturation event forces termination before scope is passed — bill the bronchoscopy CPT with -74.
Patient receives monitored anesthesia care (MAC) for a knee arthroscopy; intraoperative EKG changes halt the procedure — bill the arthroscopy CPT with -74.

Medicare: CMS Manual (Transmittal R442CP) confirms -74 is used by the facility when a procedure requiring anesthesia is terminated after induction. No payment reduction is applied.
Commercial payers (BCBS, UHC, Cigna, Aetna): Most commercial payers follow CMS guidance but verify individual payer policies. Some payers may require medical records to be submitted with the claim.
Modifier stacking: Do not stack -74 with -73 on the same procedure line. Use whichever reflects the actual point of termination.

Was this an outpatient hospital or ASC facility claim (not professional)?
Was anesthesia already administered or the procedure already initiated before termination?
Is there clear documentation of the reason for discontinuation in the operative record?
Is the terminated procedure code the correct CPT for the intended surgery?