CurrentAnthemPolicy ABCRP-0108-21

Professional Anesthesia Services

Defines Anthem Medicare Advantage reimbursement rules for professional anesthesia services including time reporting, modifier use, multiple procedure payment, obstetrical neuraxial epidural limits, services reimbursed in conjunction with anesthesia, nonreimbursable items, and modifier-specific payment percentages.

Policy Summary

PayerAnthem

PolicyProfessional Anesthesia Services

Policy CodePolicy ABCRP-0108-21

Change TypeBiennial administrative and template updates

Effective Date11/06/20

Next Review Date

Key ActionReport anesthesia services in minutes, document start/stop times, and bill the appropriate anesthesia modifier in the primary modifier field.

SourceLink

POLICY UPDATE CHANGES

Minor administrative updates to policy body and added anesthesia modifier grid during biennial review effective 11/06/20.

Policy language updated during biennial review 10/03/18.

Policy template updated during biennial review effective 01/03/17.

100%Reimbursement rate for AA/QZ modifiers

50%Reimbursement rate for QK/QX/QY

300Obstetrical epidural reimbursed up to

15Time unit increment (minutes)

Policy overview

Anthem Medicare Advantage follows CMS guidelines for reimbursement of professional anesthesia services and requires proper coding, documentation, and modifier usage. Reimbursement is based on the CMS allowance formula, specified time increments, and applicable modifiers; noncontracting providers who accept Medicare assignment are reimbursed according to original Medicare rates.

Providers must report anesthesia services in minutes with documented start and stop times (time begins with preparation for administration and ends when the provider is no longer in personal and continuous attendance). Reimbursement is calculated using the CMS-based allowance formula and time increments, and Anthem reimburses multiple procedures based on the anesthesia procedure with the highest base unit value and the overall anesthesia time.

Key topics covered include: reporting time in minutes and documentation requirements, proper use of anesthesia modifiers, payment for multiple procedures, obstetrical neuraxial epidural limits (reimbursed up to 300 minutes), separately reimbursable services provided with anesthesia, and nonreimbursable anesthesia services.

Policy metadata and thresholds

policy_numberABCRP-0108-21

effective_date11/06/20

last_review11/06/20

statusCURRENT

Obstetrical epidural time limitReimbursed up to 300 minutes; time in excess of 300 minutes requires additional documentation

Time unit increment15-minute increments where each 15-minute increment constitutes one time unit