CurrentAnthemPolicy C-09002

Anesthesia Services PDF. Opens in a new window

Defines Anthem's professional reimbursement rules for anesthesia services including time reporting, modifier usage, multiple procedures, field avoidance/unusual positioning, qualifying circumstances, oral surgery anesthesia, global/included services, postoperative pain management, and related coding impacts.

Policy Summary

PayerAnthem

PolicyAnesthesia Services PDF. Opens in a new window

Policy CodePolicy C-09002

Change TypeRevised (oral surgery language) + prior operational revisions

Effective DateMar 11, 2026

Next Review Date

Key ActionReport anesthesia services in one-minute increments in the units field, documenting start and stop times in the medical record; claims with indicators other than minutes may be rejected or denied.

SourceLink

POLICY UPDATE CHANGES

Updated language for the Anesthesia for Oral Surgery section effective 03/11/2026.

06/12/2024 updates included making qualifying circumstances always bundled, adding modifiers G8, G9 and QS to related coding, updating QZ reimbursement, and adding Physical Status Modifiers language.

Anthem does not recognize unit values for physical status modifiers and no additional reimbursement is allowed.

1Policy sections with explicit reimbursement rules

4Postoperative pain management code ranges

3Add-on anesthesia codes allowed separately

Policy overview

Anthem Policy C-09002 (Effective/Last Review: 03/11/2026) defines professional anesthesia reimbursement that follows the American Society of Anesthesiologists (ASA) anesthesia formula and incorporates National Correct Coding Initiative (NCCI) coding guidance. The policy requires minute-based time reporting with specified conversion of minutes to time units (first 4 hours: 1 unit = 5–15 minutes; after 4 hours: 1 unit = 5–10 minutes; increments under 5 minutes ignored), documentation of start/stop times, and that anesthesia time begins with preparation for anesthesia and ends when the provider is no longer in personal attendance.

Modifier and bundling rules align with ASA/NCCI: anesthesia servicing and performer-identifying modifiers must be appended (performer modifiers must be in the primary modifier field) or claims may be denied; physical status modifiers do not carry unit values or additional reimbursement. Qualifying circumstance CPT codes (e.g., 99100, 99116, 99135, 99140) are always bundled and not separately reimbursed.

Scope: the policy covers time reporting and unit calculation, proper use and sequencing of anesthesia modifiers (including servicing and physical status modifiers), bundling rules for qualifying circumstances and included services, handling of multiple procedures (only the anesthesia code for the most complex service is reported; base units apply only to the primary procedure; exceptions for add-on codes 01953, 01968, 01969), field avoidance/unusual positioning base value rules (minimum base value 5 for certain locations), oral surgery coding interactions (CDT vs CPT and modifier 47 rules), global versus separately payable services (what is included in global anesthesia reimbursement vs services eligible for separate payment such as certain postoperative pain management injections/catheters and select invasive lines/TEE per NCCI), and medication reporting constraints in facility settings.

Policy number: C-09002. Effective Date / Last Approval Date: 03/11/2026.

Billing, modifier and documentation requirements

Billing Rule

Report anesthesia time in minutes and document start/stop

Report anesthesia services in one-minute increments in the units field and document start and stop times in the medical record. Time reporting uses one-minute increments; for the first 4 hours one unit = 5–15 minutes, after 4 hours one unit = 5–10 minutes, and increments under 5 minutes are ignored. Claims submitted with an indicator other than minutes may be rejected or denied.

Billing Rule

Use appropriate primary modifier field for who performed anesthesia

Append anesthesia modifiers that identify who performed the service in the primary modifier field to receive appropriate reimbursement. Modifiers identifying the performer must be billed in the primary modifier position; claims without the appropriate modifier will be denied. Note that these modifiers affect reimbursement percentages and servicing modifiers must be ordered appropriately to ensure correct payment.

Primary (first) modifier field must contain performer-identifying modifiers to establish correct pay percent and reimbursement.

Operational coverage rules and criteria

Time reporting and units

Providers must report anesthesia time and units as follows:

Report anesthesia services in one-minute increments and note in the units field.

For the first four (4) hours: one (1) unit equals five (5) to fifteen (15) minutes.first 4 hours: 1 unit = 5-15 minutes

After the first four (4) hours: one (1) unit equals five (5) to ten (10) minutes.after 4 hours: 1 unit = 5-10 minutes

Any time increments less than five (5) minutes will be ignored in reimbursement calculations.<5 minutes ignored

Code lists and coverage status

Qualifying circumstance CPT codes (bundled/not separately reimbursed)CPTNot Covered

99100	Anesthesia for patient of extreme age, younger than 1 year and older than 70.
99116	Anesthesia complicated by utilization of the total body hypothermia.
99135	Anesthesia complicated by utilization of controlled hypotension.
99140	Anesthesia complicated by emergency conditions.

Oral surgery CDT anesthesia codes (allowed when billed alone)HCPCSCovered

D9211	General anesthesia, not otherwise specified (dental)
D9212	General anesth. deep sedation (examples) - range up to D9248
D9248	Other anesthesia for dental procedure (end of D9211-D9248 range)

CPT anesthesia codes not allowed with CDT on same dateCPTNot Covered

00170-00176

Anesthesia for intraoral procedures (not eligible when reported with CDT procedures)

Postoperative pain management (eligible for separate reimbursement)CPTCovered

62320-62327	Injection or catheter placement codes (epidural/spinal) for pain management
64400-64450	Nerve block injection codes (major nerve blocks)

Daily hospital management of epidural/subarachnoid continuous drug administrationCPT

01996

Daily hospital management of epidural or subarachnoid continuous drug administration

Add-on anesthesia codes eligible for separate reimbursementCPTCovered

01953	Anesthesia for other than that ordinarily required for concomitant procedure (add-on)
01968	Anesthesia for an emergency or add-on
01969	Anesthesia for lengthy procedures (add-on)

TEE and echocardiography related codes (separate reimbursement conditions)CPT

93312-93317	TEE codes potentially separately reimbursable if distinct and proper modifier appended
93318	TEE for monitoring (considered incidental; modifier will not override)
93355	TEE guidance for transcatheter intracardiac/great vessel intervention (incidental per NCCI)

Medication/drug codes separately reported by professional in facilitymixedNot Covered

J3490

Unclassified drug code example (drugs separately reported in facility setting not eligible for separate reimbursement)

Key terms

Background and evidence sources

Anthem’s anesthesia reimbursement approach is based on the ASA anesthesia formula (Base Units derived from the ASA Anesthesia Relative Value Guide) and applies NCCI coding guidelines to determine which services are included in the anesthesia global and which may be separately reimbursable. Base Units (BU), Conversion Factor (CF), and Time Units (TU) are defined consistent with ASA guidance and the policy specifies minute-based reporting and the TU conversion rules.

NCCI alignment is reflected in inclusion/exclusion determinations (for example, echocardiography, EEG, inhalation treatments, non‑invasive monitoring, endotracheal tube placement, peripheral IV placement, venipuncture/transfusion, and routine pre/post E/M within the defined global periods are considered included and not separately payable). Anthem follows NCCI edits for transesophageal echocardiography (TEE): 93312–93317 may be separately reimbursable if performed as a distinct procedure with the appropriate modifier; monitoring/incidental TEE codes (e.g., 93318) and guidance codes (e.g., 93355) are incidental and a bypass modifier will not override the edit.

The policy clarifies separate-payment exceptions consistent with ASA/NCCI: postoperative pain management injections/catheter placements into the epidural space or major nerve (CPT 62320–62327, 64400–64450) are eligible for separate reimbursement (time units not applicable), and select invasive procedures (Swan-Ganz, CVP line, intra‑arterial lines) and distinct TEE procedures may be separately reimbursed when reported and modified per NCCI logic.

Evidence: Anthem states the policy was developed with consideration of CMS and Optum EncoderPro 2023.

Policy revision timeline

2011-06-07revised

Policy history entry notes system handling of physical status modifiers and guidance for providers to add appropriate units when appending P3-P5 (administrative/operational update).

2024-06-12revised

Operational updates recorded: qualifying circumstances set to always bundle; modifiers G8, G9, and QS added to related coding; QZ reimbursement updated; Physical Status Modifiers language added.

2026-03-11revisedLatest

Policy Summary

PayerAnthem

PolicyAnesthesia Services PDF. Opens in a new window

Policy CodePolicy C-09002

Change TypeRevised (oral surgery language) + prior operational revisions

Effective DateMar 11, 2026

Next Review Date

SourceLink

On This Page

Billing Rule

Do not bill secondary anesthesia codes for multiple procedures

When multiple surgical procedures occur, report only the anesthesia code for the most complex (primary) service. Base units apply only to the primary procedure; secondary procedure anesthesia codes are not billed separately. If two separate anesthesia codes are reported, the lesser-charge procedure will be denied unless Anthem documents a separate subsequent operative session (>1 hour separation). Exceptions: add-on anesthesia codes 01953, 01968, and 01969 are eligible for separate reimbursement in addition to the primary code.

01953
01968
01969

Denial Risk

Medication charges in facility setting

When an anesthesia professional separately reports medications in a facility setting, those drug charges (including unclassified drug codes) are not eligible for separate reimbursement because the facility's charge is considered to include medications. Such separately reported medication charges will be denied.

J3490

Documentation Required

Document continuous vs interrupted anesthesia time

If anesthesia time is interrupted, document the interruption as blocks of time showing continuous anesthesia services provided during the counted periods. Proper documentation of interruptions is required to support counting fragmented/blocked anesthesia time.

Billing Rule

Pain management billing rules

Postoperative pain management injections or catheter placements into the epidural space or major nerve (CPT ranges 62320-62327 and 64400-64450) are eligible for separate reimbursement and are not time-unit based. When performed bilaterally, report the unilateral code once with modifier 50 and the allowance will be 150% of the code's allowance. CPT 01996 (daily hospital management of epidural/subarachnoid continuous drug administration) is payable once per date following surgery but will be denied when billed with an anesthetic injection code (e.g., 62320-62327) or when billed with physical status/qualifying circumstance modifiers; modifiers will not override these edits.

Relevant codes: 62320-62327, 64400-64450, 01996
When bilateral, report once with modifier 50; allowance = 150%
01996 will be denied if billed with injection codes or with physical status/qualifying circumstance modifiers

Billing Rule

TEE modifier and NCCI edits

Transesophageal echocardiography (TEE) codes 93312-93317 may be eligible for separate reimbursement only when performed as a distinct and independent procedure from anesthesia and the appropriate modifier is appended. TEE monitoring/guidance codes (e.g., 93318 and 93355) are considered incidental per NCCI edits and a bypass modifier will not override the edit.

Distinct TEE codes: 93312-93317
Monitoring/guidance considered incidental: 93318, 93355

Start and stop times must be documented in the member's medical record.

Anesthesia time starts with preparation of the member for administration of anesthesia and stops when the anesthesia provider is no longer in personal attendance.

Anesthesia time can be counted in blocks if there is an interruption, as long as time counted is continuous anesthesia services provided.

Anesthesia claims submitted with an indicator other than minutes may be rejected or denied.

Claims submitted with an indicator other than minutes may be rejected or denied

Anesthesia Modifiers and physical status modifiers

Modifier requirements and reimbursement rules:

Append anesthesia modifiers to the applicable procedure code to indicate the specific anesthesia service or who performed the service.

Modifiers identifying who performed the anesthesia must be billed in the primary modifier field to receive appropriate reimbursement.

Claims submitted without the appropriate modifier will be denied.

Total reimbursement for services provided by a physician and a non-physician anesthesia provider will not exceed 100% of the eligible amount had the physician alone provided the service.

Anthem does not recognize unit values for physical status modifiers and no additional reimbursement is allowed.

Physical status modifiers do not add units and are not reimbursed.

Multiple procedures

Reporting when multiple surgical procedures occur:

When anesthesia services are provided for multiple surgical procedures, only the anesthesia procedure code for the most complex service should be reported.

Base units are only used for the primary procedure and not for secondary procedures.

If two separate anesthesia codes are reported, the procedure with the lesser charge will be denied.

Exception: Add-on codes 01953, 01968, and 01969 are eligible for separate reimbursement in addition to the primary procedure code.

Includes add-on codes 01953, 01968, 01969

If Anthem determines a separate subsequent operative session took place with more than an hour separation from the initial anesthesia, the second subsequent anesthesia service may be eligible for separate reimbursement.>1 hour separation may allow separate reimbursement

Field avoidance and unusual positioning

Reimbursement adjustments for certain operative locations/positions:

Any procedure around the head, neck, or shoulder girdle requiring field avoidance, or any procedure requiring a position other than supine or lithotomy, has a minimum base value of 5 regardless of lesser base value assigned to the procedure.Minimum base value of 5

Unusual positioning is not eligible for additional reimbursement even when reported with modifier 22.

Modifier 22 does not make unusual positioning eligible for additional reimbursement.

Qualifying circumstances (bundling)

Qualifying circumstance codes are always bundled and not eligible for separate reimbursement:

Qualifying circumstances are always bundled when reported in addition to the anesthesia procedure/service provided.

Qualifying circumstance CPT codes

99100 Anesthesia for patient of extreme age, younger than 1 year and older than 70.
99116 Anesthesia complicated by utilization of the total body hypothermia.
99135 Anesthesia complicated by utilization of controlled hypotension.
99140 Anesthesia complicated by emergency conditions.

Anesthesia for Oral Surgery

Rules when oral surgery is reported with CDT or CPT anesthesia codes:

Anthem allows reimbursement for anesthesia for covered oral surgical procedures reported with appropriate CDT-based anesthesia codes (D9211 - D9248).

Mutually exclusive reporting

CPT anesthesia codes 00170 - 00176 are not eligible for reimbursement when reported with a CDT procedure.
CDT anesthesia codes D9211 - D9248 are not eligible for separate reimbursement when reported with CPT procedure codes.

If an oral surgeon reports services with a CPT procedure and also provides an anesthesia service, append modifier 47. In this instance there is no additional reimbursement for the anesthesia; only the oral surgery procedure is eligible.

Services included/excluded in global reimbursement for anesthesia

Services considered included in the global anesthesia reimbursement and exceptions:

Included (not separately reimbursed)

Daily hospital management of patient-controlled analgesia.
Echocardiography.
Electroencephalogram.
Inhalation treatments.
Laryngoscopy and bronchoscopy procedures.
Placement and interpretation of any non-invasive monitoring (ECG, temperature/BP/pulse oximetry, CO2 capnography, mass spectrometry, vital capacity).
Placement of endotracheal and naso-gastric tubes.
Placement of peripheral IV lines and administration of fluids, anesthetic or other medications through a needle or tube into a vein.
Venipuncture and transfusion.

One-day preoperative E/M services and 10-day postoperative E/M services are considered included in the anesthesiologist's global reimbursement; the 10-day postoperative period includes follow-up E/M and postoperative pain management related to the surgical episode.

Nerve block injections (for pain management) are eligible for separate reimbursement.

Facility-administered medication and separate reporting

Medication billing when reported separately by an anesthesiology professional in facility setting:

When an anesthesia professional separately reports a medication in a facility setting, the medication will not be eligible for separate reimbursement even when reported with an unclassified/unspecified drug code; facility's charge includes provision of any medication (including Propofol).

References J3490 as example of unclassified drug code in BRIEF

TEE reimbursement rules

For TEE (CPT codes 93312-93317): if performed as distinct and independent procedure from anesthesia, appropriate modifier must be appended to be eligible for separate reimbursement.
If TEE services are for monitoring (e.g., 93318) or guidance of transcatheter intracardiac/great vessel interventions (e.g., 93355), Anthem will follow NCCI edit logic and consider the codes incidental; a bypass modifier will not override.

Postoperative pain management

Rules for separate reimbursement of postoperative pain management services:

Postoperative pain management injections or catheter insertions into the epidural space or major nerve by an anesthesiologist are eligible for separate reimbursement; time units are not applicable.

Applies to codes/ranges: 62320-62327 and 64400-64450.

When performed bilaterally, report the unilateral code once with modifier 50; the pain management code will be considered one surgical service eligible for reimbursement equal to 150% of the allowance for the code.bilateral with modifier 50 => 150% allowance

CPT 01996 (daily hospital management of epidural/subarachnoid continuous drug administration) is payable once per date post-surgery; when billed with an anesthetic injection code (e.g., 62320-62327), only the injection code is eligible and modifiers will not override edits.01996 payable once per date; denied when billed with injection codes

Anthem will deny CPT 01996 when billed with a physical status modifier or qualifying circumstance procedure codes.

Updated language for the Anesthesia for Oral Surgery section clarifying interactions between CPT and CDT anesthesia codes and requiring modifier 47 when an oral surgeon reports a CPT procedure and also provides anesthesia (no additional reimbursement for the anesthesia).

clarified

Anthem does not recognize unit values for physical status modifiers and no additional reimbursement is allowed.