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2025 HCPCS code P1

A normal healthy patient.

This modifier is used only with anesthesia codes (00100-01999). It should not be used with other procedure codes. Only the anesthesia provider is responsible for appending this modifier.

No

Modifier P1 is used to reflect the patient’s health status at the time of anesthesia administration.While it does not typically affect reimbursement under Medicare, some commercial payers may utilize it for payment adjustments.

It is important to note that this modifier is appended by the anesthesia provider, not the coder.

IMPORTANT:P2-P6 represent different levels of patient health status for anesthesia billing.Use the appropriate modifier.

In simple words: This code is used when a healthy person receives anesthesia for a medical or surgical procedure.

This modifier is appended to an anesthesia code to indicate that the patient receiving anesthesia is a normal, healthy individual.This typically includes patients with no significant physiologic or psychiatric disorders and a good level of exercise tolerance. It excludes very young or very old individuals. The medical record should support the assessment of the patient as normal and healthy.

Example 1: A 30-year-old healthy adult undergoes an elective knee arthroscopy. The anesthesiologist appends P1 to the anesthesia code., A 25-year-old healthy pregnant woman undergoes a planned cesarean delivery. Modifier P1 is added to the anesthesia billing code by the anesthesiologist, as pregnancy itself does not change the P1 designation., A healthy 45-year-old individual with no medical history has an elective hernia repair under general anesthesia. Modifier P1 is added by the anesthesiologist to the anesthesia record for the procedure.

The medical record must clearly document the patient’s health status as normal and healthy to support the use of modifier P1.

** Medicare and some other payers do not provide additional reimbursement for modifier P1, as it represents a normal healthy patient.It is however still important to utilize to fully represent the state of the patient at the time of the procedure.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.

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