Anesthesia claims must be billed using CPT anesthesia five-digit procedure codes or CPT surgical codes with appropriate anesthesia modifiers; report a single anesthesia code for the most complex service when one code describes the service and include combined time for all procedures.
Allowable payment for in-network professional providers equals (Time Units + Base Units) x Conversion Factor; base units are those in effect in the ASA Relative Value Guide on the date of service.
Time units: measured in 15-minute increments for the first 2 hours, then 10-minute increments thereafter; anesthesia time begins when the provider physically starts patient preparation for induction and ends when the provider is no longer in constant attendance.
Qualifying circumstance add-on codes (e.g., 99100, 99116, 99135, 99140) may be billed only in conjunction with the anesthesia service having the highest base unit value and have specified unit values; qualifying circumstance allowance = qualifying circumstance unit value x conversion factor.
The following services are included in base unit value and are not separately reimbursable: preoperative and postoperative visits; laryngoscopy/bronchoscopy; administration of fluids and/or blood products incident to anesthesia (including venipuncture/introduction of needle or catheter); retrobulbar injection; cardiopulmonary resuscitation, cardioversion, temporary pacemaker, or inhalation treatments.
When multiple surgical procedures occur during a single anesthesia administration, report only the anesthesia code with the highest base unit value plus the combined total anesthesia time for all procedures; secondary general anesthesia codes will be denied except for add-on anesthesia codes (for example 01953, 01968, 01969).
Duplicate anesthesia services billed for the same patient on the same date by the same or different providers will result in reimbursement only for the first submission of that code; simultaneous physician and CRNA services may be reported when provided concurrently using the appropriate modifiers.
Certain procedure codes may be excluded from the time-and-points methodology; refer to specific fee schedules and code-edit software in use for the date of service. Routine postoperative evaluation is included in the base unit and related postoperative E/M services are not separately reportable by the anesthesiologist except for significant, separately identifiable critical care services.
Modifier guidance: use anesthesia and second-position modifiers as specified (e.g., AA, AD, QK, QX, QZ and QS, G9, GC, GE, GF) and other applicable modifiers (e.g., 22, 23, 47) per CPT and policy guidance; physical status modifiers (P1–P6) classify patient risk but do not determine payment.
Documentation requirement: when using Modifier 22 for substantially greater work (for example field avoidance), documentation must be included in the anesthesia record and meet the policy criteria (base unit < 5, procedure performed around head/neck/shoulder, and/or non‑supine position) to support additional payment.
Claims are subject to code-edit protocols and the terms of the provider contract; provider documentation must support billed services and the Plan may request additional documentation during claim review.
Tumescent anesthesia included in endovenous ablations is not separately reimbursable.