CurrentBlue Cross Blue Shield - MainePolicy C-09002

Anesthesia Services

Defines billing, coding, time reporting, modifiers, included/excluded services, qualifying circumstances, oral surgery rules, postoperative pain management, and related coding exemptions for professional anesthesia services under the payer's commercial reimbursement policy (C-09002).

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyAnesthesia Services

Policy CodePolicy C-09002

Change TypeCoding and operational clarifications (medication reimbursement clarified)

Effective DateMar 11, 2026

Next Review Date

Key ActionReport anesthesia services in one-minute increments and convert minutes to units by dividing by 15 and rounding to the nearest tenth; claims with other indicators may be denied.

SourceLink

POLICY UPDATE CHANGES

Document lists revision history entries with multiple prior updates (06/12/2024, 12/17/2024, 10/06/2025) but latest entry indicates Last Approval Date 03/11/2026 and Effective Date 03/11/2026.

Updated language that medication reported by an anesthesia provider in a facility place of service will not be eligible for separate reimbursement (e.g., J3490).

Updated section for postoperative pain management to include phrase 'postoperative' regarding pain management services.

Removed obstetrical anesthesia section from the policy.

Updated miscellaneous coding and modifier guidance (e.g., AS modifier expansion, QK/QX/QY reduction applicability to 60000 series).

ManyAnesthesia codes and modifiers referenced

Policy overview and scope

This commercial reimbursement policy (C-09002) governs professional anesthesia services, outlining payer-specific billing and coding rules, modifier requirements and placement, time reporting and unit calculation, included and excluded services in the global anesthesia payment, qualifying circumstance bundling, special oral surgery rules (CDT vs CPT), and postoperative pain management rules. Key topics covered include billing and coding guidance (including anesthesia and CDT code interactions), servicing and physical status modifiers and the requirement that servicing modifiers be billed in the primary modifier field, one-minute time reporting converted to 15-minute time units (minutes divided by 15 and rounded to the nearest tenth), base value adjustments for field avoidance/unusual positioning (minimum base value = 5), qualifying circumstance codes that are always bundled, that medications reported by a professional in a facility (including unclassified drug codes) are not eligible for separate reimbursement, and that specified postoperative pain management injection/catheter codes (e.g., CPT ranges 62320-62327, 64400-64450) may be eligible for separate reimbursement with defined billing rules. Effective Date and Last Approval/Review Date: 03/11/2026.

Policy header

Policy numberC-09002

Effective date03/11/2026

Last approval/last review03/11/2026

Coverage stanceBilling and reimbursement rules for professional anesthesia services (commercial payer policy)

Scope summaryDefines billing, coding, time reporting, modifiers, included/excluded services, qualifying circumstances, oral surgery rules, postoperative pain management, and related coding exemptions for professional anesthesia services.

Medication reimbursement stanceMedication charges reported by a professional provider in a facility place of service (including unclassified drug codes) are included in the facility charge and not eligible for separate reimbursement.

Last approval/effective noted in changesLast Approval Date and Effective Date: 03/11/2026

Reimbursement criteria and core rules

General Reimbursement Principles

Anesthesia services are reimbursed when the following general principles are met:

General Principles

ASA formula: Reimbursement based on American Society of Anesthesiologists (ASA) anesthesia formula unless otherwise noted in exemptions.
Modifier placement: Modifiers identifying who performed the anesthesia must be billed in the primary modifier field to receive appropriate reimbursement; proper use of physical status and servicing modifiers is required.
Claims submitted without the appropriate modifier will be denied.
Additional factors such as field avoidance and unusual positioning may affect base value.

Code lists and modifier guidance

Oral surgery CDT anesthesia codes (CDT range)NDC|mixedCovered

D9211-D9248

CDT anesthesia codes for oral surgical procedures (eligible when reported alone and applicable)

CPT anesthesia codes not eligible with CDT (intraoral anesthesia)CPTNot Covered

00170-00176

Anesthesia for intraoral procedures — not eligible when reported with CDT procedures

Postoperative pain management codes (eligible separately)CPTCovered

62320-62327	Epidural/major nerve injection or catheter insertion codes — eligible for separate reimbursement; time units not applicable
64400-64450	Nerve block codes range — postoperative pain management injections/catheter insertions eligible for separate reimbursement
01996	Daily hospital management of epidural/subarachnoid continuous drug administration — eligible once per date of service post-surgery; denied when billed with physical status or qualifying circumstance codes; not eligible when billed with 62320-62327 (only injection reimbursed)

TEE and related echocardiography codesCPT

93312-93317	TEE codes — may be eligible separately if performed distinct and independent from anesthesia and appropriate modifier appended per NCCI guidance
93318	TEE monitoring — considered incidental to anesthesia and not separately reimbursed (0-superscript; modifier bypass will not override)
93355	TEE guidance of transcatheter intracardiac/great vessel structural intervention — considered incidental per NCCI; separate reimbursement not allowed

Anesthesia modifiers and servicing modifiers (pay percent modifiers)Modifier

AA	Anesthesiologist personally performed anesthesia service — servicing modifier; must be billed in primary modifier field
AD	Medical supervision by physician — patient under care of multiple anesthesia providers; billed in primary modifier field
QK	Medical direction of 2-4 CRNAs/Anesthesia Assistants — pay percent modifier; must be billed in the primary modifier field
QX	CRNA service with medical direction — pay percent modifier; must be billed in the primary modifier field
QY	Medical direction of one CRNA — pay percent modifier; must be billed in the primary modifier field
QZ	CRNA without medical direction — pay percent modifier; reimbursement varies by state/fee schedule; primary modifier field required
G8	Informational (Monitored Anesthesia Care) — listed in related coding; may cause denial with general anesthesia codes; informational only
G9	Informational (Monitored Anesthesia Care) — listed in related coding; informational only
QS	Monitored anesthesia care service modifier — informational in related coding
22	Unusual procedural services — modifier will not allow additional reimbursement for unusual positioning

1–10 of 12

1/2

Mentioned CPT/HCPCS/Drug coding examples and references (document references many code edits historically)mixed

01953	Anesthesia add-on code (historical example referenced as separately reimbursed)
01968	Anesthesia add-on code (historical example referenced as separately reimbursed)
01969	Anesthesia add-on code (historical example referenced as separately reimbursed)
31500	Endotracheal intubation — referenced in policy history as included in global anesthesia services
43200	Esophagoscopy/EGD — referenced in coding updates
43754	Enteric tube placement — referenced historically
43753	Enteric tube placement — referenced historically
93317	Cardiac ultrasound code — referenced in related coding
93318	Cardiac ultrasound monitoring code — referenced as incidental/0-superscript in edits
93015	Cardiac monitoring code — referenced as removed from list historically

1–10 of 16

1/2

Billing, documentation, and denial-risk highlights

Billing Rule

Report anesthesia time in minutes and calculate units

Report anesthesia time in minutes in the minutes field and calculate time units by dividing total minutes by 15 and rounding to the nearest tenth. Claims submitted with an indicator other than minutes may be rejected or denied.

Report anesthesia time in one-minute increments.
Units = minutes ÷ 15, rounded to the nearest tenth.

Billing Rule

Primary modifier field requirement

Modifiers identifying who performed the anesthesia must be billed in the primary modifier field. Claims submitted without the appropriate primary modifier will be denied.

Affected modifiers: AA, AD, QK, QX, QY, QZ
Place the provider-identifying modifier in the primary modifier field on the claim; do not place it only in an information or secondary modifier slot.

Key terms

Definitions

Anesthesia time unitOne unit equals 15 minutes; units = minutes/15 rounded to nearest tenth.

Qualifying circumstancesCertain anesthesia situation codes (e.g., age extremes, controlled hypotension, emergency conditions) that are considered bundled into anesthesia payment and not separately reimbursed.

AnesthesiaRefers to the drugs or substances that cause a loss of consciousness or sensitivity to pain.

Base Units (BU)Assigned to a specific anesthesia CPT code and derived from the ASA Anesthesia Relative Value Guide (RVG).

Conversion Factor (CF)A geographic-specific amount that varies by the locality where the anesthesia is administered.

GeneralDrug-induced loss of consciousness during which patients are not arousable, even by painful stimulation.

Operational FAQs and clarifications

Quick Q&A

Common Billing Pitfalls & Quick Fixes

Document changes and effective dates

2024-06-12revision

Review approved 06/12/2024: multiple updates including qualifying circumstances bundling, added modifiers G8/G9/QS to Related Coding, updated QZ reimbursement and added Physical Status Modifiers and market exemptions.

2024-12-17revision

Review approved 12/17/2024: updated Indiana exemption (allows reimbursement for qualifying circumstances when reported in addition to the primary procedure).

2025-10-06regulatory_update

Update due to regulatory directive 10/06/2025: added Ohio exemption; reviewed 10/06/2025 and effective 11/01/2025.

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyAnesthesia Services

Policy CodePolicy C-09002

Change TypeCoding and operational clarifications (medication reimbursement clarified)

Effective DateMar 11, 2026

Next Review Date

Key ActionReport anesthesia services in one-minute increments and convert minutes to units by dividing by 15 and rounding to the nearest tenth; claims with other indicators may be denied.

SourceLink

On This Page

Billing Rule

Multiple-provider reimbursement cap

When anesthesia is provided by both a physician/anesthesiologist and a non-physician anesthesia provider, combined reimbursement will not exceed 100% of the amount that would be allowed had the anesthesia been provided by the physician/anesthesiologist alone.

Billing Rule

Multiple procedure reporting

Only the anesthesia procedure code for the most complex service should be reported when multiple procedures are performed. Base units apply only to the primary procedure. If two separate anesthesia procedure codes are reported for the same continuous anesthetic episode, the lesser procedure will be denied.

Exception — add-on anesthesia codes 01953, 01968, and 01969 may be reported in addition to the primary anesthesia code.
Report the code for the most complex service as the primary anesthesia code; secondary procedures should not be reported except for the listed add-on codes.
If the health plan determines a subsequent separate operative session occurred (>1 hour separation), the second service may be eligible for separate reimbursement.

Documentation Required

Document start and stop times

Document start and stop times in the member's medical record. The medical record must support the minutes reported on the claim.

Document preparation/start time and the time the anesthesia provider is no longer in personal attendance (stop time).
Keep contemporaneous anesthesia records to substantiate minutes billed to avoid denial or recoupment.

Billing Rule

Oral surgery reporting

For oral surgery, report either CPT anesthesia codes 00170–00176 or CDT anesthesia codes D9211–D9248, but not both for the same date of service. When an oral surgeon reports a CPT procedure and also provides the anesthesia service, modifier 47 must be appended and no additional anesthesia reimbursement will be allowed.

CPT codes: 00170-00176
CDT codes: D9211-D9248
If CPT anesthesia codes for intraoral procedures are billed with CDT procedures for the same date of service, CPT anesthesia codes will not be eligible for reimbursement.
When an oral surgeon appends modifier 47 to a CPT surgical procedure, no separate anesthesia reimbursement is payable.

Billing Rule

Medications in facility setting

Medications reported by the professional anesthesia provider in a facility setting (including Propofol) are not separately reimbursed when included on the anesthesia claim. Use appropriate J-codes/HCPCS as required by facility billing policies, but medications billed by the professional anesthesia provider in the facility are bundled into the anesthesia payment and are subject to denial.

Example: Propofol reported by the professional anesthesia provider in a facility setting is not separately reimbursable.
If medications are billed separately by the facility (e.g., J3490) follow facility billing rules; professional anesthesia medication charges in the facility are bundled and may be denied if submitted for separate payment.

Billing Rule

TEE separate reimbursement requirement

Certain transesophageal echocardiography (TEE) services have separate reporting rules. Some echocardiography codes are incidental to anesthesia and are not separately payable in accordance with NCCI edits; modifiers may be required to indicate distinct procedural service when appropriate.

TEE codes: 93312-93317, 93318, 93355
When echocardiography is a separate, reportable service, append the appropriate modifier per guidance; otherwise TEE services that are incidental to anesthesia are not payable.
NCCI edits apply; modifier 59 may not override some TEE-related NCCI edits.

Billing Rule

Postoperative pain management billing

Postoperative pain management services have specific reporting and payment rules. Follow bilateral reporting and allowance rules, and observe frequency limitations for certain add-on services.

Relevant codes: 62320-62327, 64400-64450, 01996
Bilateral procedures: report per established bilateral coding guidance; in general, bilateral peripheral procedures may be allowed at 150% of the listed allowance when appropriate.
01996 (daily hospital management) is allowed only once per date of service and is not separately payable when billed with injection/nerve block codes; it will be denied if reported with injection codes that represent the same service.
Interaction/denial: 01996 and similar daily management codes are subject to denial when reported in conjunction with injection codes for postoperative nerve blocks.

Denial Risk

Denial for daily management with physical status or qualifying circumstance

Do not report CPT 01996 (daily hospital management) on the same claim with a physical status modifier or with qualifying circumstance codes; 01996 billed with a physical status modifier or qualifying circumstance will be denied.

01996 when billed with a physical status modifier (P modifiers) or qualifying circumstance CPT codes (e.g., 99100, 99116, 99135, 99140) is subject to denial.

Documentation Required

Time units and base units reporting and medical record support

Report base units per the ASA Relative Value Guide (RVG) and apply the appropriate locality conversion factor when calculating reimbursement. The medical record must fully support billed base units, time units, modifiers, and services; insufficient documentation may result in denial or recoupment.

Base units are those listed in the ASA RVG for the reported anesthesia code and are used with reported time units to calculate total units.
Convert units to dollar reimbursement using the plan's locality conversion factor.
Maintain anesthesia records, start/stop times, block details, and medication documentation to substantiate billed services and units; lack of medical record support may lead to denial or recoupment.

Billing Rule

Modifiers and edits

Specific modifier and edit interactions apply to anesthesia claims. Some modifiers expand or reduce reimbursement; others cannot override NCCI edits. Follow coding guidance carefully to avoid denials.

Modifier AS: follow plan expansion rules where applicable.
Modifiers QK/QX/QY reduce reimbursement when applied to the 60000-series anesthesia codes per plan edits.
93318 and certain TEE-related edits are non-overridable; modifier 59 may not be used to bypass some NCCI edits for TEE services.

Billing Rule

Obstetrical anesthesia

Obstetrical anesthesia has been removed from this policy and is governed by local contracting. Local plan documents may contain specific obstetrical anesthesia guidance.

OB anesthesia is excluded from this statewide policy and managed via local contracts.
Providers should consult local plan language for any obstetrical anesthesia reimbursement rules.

Billing Rule

Global period and postoperative nerve blocks

Global surgical period rules apply to postoperative nerve blocks and related services. If a nerve block is inclusive in the global surgical package, it is not payable separately; otherwise, follow global period applicability and bundling rules.

Postoperative nerve blocks billed during a procedure's global period are subject to global period bundling rules.
Verify the global period for the primary surgical procedure to determine separate reimbursement eligibility for postoperative nerve blocks.

2026-03-11approvalLatest

Last Approval Date/Effective Date 03/11/2026: clarified that medications reported by an anesthesia provider in a facility place of service (e.g., J3490) are not eligible for separate reimbursement (facility charge included); wording updates also include postoperative pain management phrasing adjustments and other non-criteria edits.