ModifiedBlue Cross Blue Shield - OklahomaPolicy CPCP010

Anesthesia Information - Professional Provider

Defines billing, coding, and reimbursement rules for professional anesthesia services for Blue Cross and Blue Shield of Oklahoma members and participating providers.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyAnesthesia Information - Professional Provider

Policy CodePolicy CPCP010

Change TypeMaterial revisions including code table updates

Effective DateNovember 1, 2025

Next Review Date

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request; claims are subject to claim review.

SourceLink

POLICY UPDATE CHANGES

Title revised; Grammatical updates; Clarification added for time; Clarification added for modifier 22; CPT code 01996 added to table for Procedure codes allowed for base point units, CPT codes 01991 and 01992 removed; References updated.

CPT code 01996 added to table for Procedure codes allowed for base point units.

CPT codes 01991 and 01992 removed from the table of Procedure codes allowed for base point units.

100%CRNA/AA reimbursement

15 / 10Time unit increments

5Base unit threshold

01996Daily management code

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

General anesthesia code range

Anesthesia Coverage and Payment Rules

Payment calculation and time/base unit rules

Payment methodology and what composes payable units

Total units allowed = (time units + base units value) x conversion factor

Time units: anesthesia time measured and converted to units using 15-minute increments for the first 2 hours then 10-minute increments thereafter

Anesthesia time begins when the provider physically starts to prepare the patient for induction and ends when the provider is no longer furnishing anesthesia care.

Base points: determined from the ASA Relative Value Guide in effect on the date of service; newly established codes paid at existing rates until update implemented

Qualifying circumstance add-on procedure codes must be used only in conjunction with the anesthesia service with the highest base unit value; allowed amount = qualifying circumstance value x conversion factor

Qualifying circumstance codes are conditions that significantly impact the anesthetic service.

Limitations and exclusions

Limitations, exclusions, and duplicate/multiple service rules

Certain procedure codes may be excluded from the time-and-points methodology; refer to specific fee schedules

Routine postoperative evaluation and routine services, supplies and equipment are included in the base unit and are not separately reimbursable

Includes pre/postoperative visits, administration of fluids/blood, laryngoscopy/bronchoscopy, retrobulbar injection, CPR/cardioversion/temporary pacemaker/inhalation treatments, and reusable/disposable equipment.

When duplicate anesthesia services are billed for the same patient on the same date of service by the same or different provider, the claim will be denied

Plan reimburses only the first submission of a duplicate code.

For multiple surgical procedures during a single anesthesia administration, report only the single anesthesia code with the highest base unit value plus combined time for all procedures

If multiple general anesthesia codes (00100-01999) are submitted, only the highest submitted charge will be reimbursed; secondary general anesthesia services will be denied. Exceptions apply for add-on anesthesia codes (e.g., 01953, 01968, 01969).

Anesthesia reimbursement criteria

Reimbursement rules for anesthesia services addressed in this section:

Only the first submission of a duplicate anesthesia code for the same patient on the same date of service will be reimbursed; simultaneous physician and CRNA administration may be reported with appropriate modifiers

Tumescent anesthesia is considered included in endovenous ablation procedures and is not separately reimbursable

Procedure Codes, Modifiers, and Unit Examples

Anesthesia CPT codes and examplesCPTCovered

00100-01999	Anesthesia procedure code range for general anesthesia services
+01968	Anes/Analg CS deliver add-on (time only)
+01969	Anesth/Analg CS hyst add-on (time only)
01996	Daily anesthesia management (base points only)

Procedure codes changed in update historyCPT

01996	CPT code added to procedure codes allowed for base point units (per update)
01991	CPT code removed from procedure codes allowed for base point units (per update)
01992	CPT code removed from procedure codes allowed for base point units (per update)

Total units calculation

Total units formulaTotal units = (time units + base units) x conversion factor

Components included in time/base calculationTime units (per anesthesia time) plus base unit value from ASA Relative Value Guide

Conversion to allowable amountAllowable amount = conversion factor multiplied by total units

Terms and Modifiers

Anesthesia service components

Included servicesPre-operative and post-operative visits, anesthesia care during procedure, administration of fluids and/or blood, physiological monitoring (e.g., ECG, temperature, blood pressure, oximetry, capnography, mass spectrometry), and other supportive services

Separate-reportable catheter insertionsIntra-arterial, central venous, and Swan-Ganz catheter insertion are allowed separately

Coding guidanceBill anesthesia administration with CPT five-digit anesthesia procedure codes or CPT surgical codes plus appropriate modifier; report a single code when one describes services

Physical status modifiers (ASA)

ASA levelsASA physical status modifiers P1–P6 (P1 = healthy; P2 = mild disease; P3 = severe systemic disease; P4 = severe disease constant threat to life; P5 = moribund not expected to survive without operation; P6 = brain-dead donor)

Documentation, Billing, and Claim Submission Guidance

Documentation Required

Documentation and claim review — submit accurate documentation and provide records on request

Providers are responsible for submission of accurate documentation of services performed and must code claims using valid HIPAA-approved code sets and industry-standard coding guidelines. Claims are subject to code edit protocols and claim review (including benefit coverage, provider contract language, medical policies, and coding software logic); upon request, providers should submit additional documentation to support the claim.

Billing Rule

Duplicate anesthesia reimbursement — only first submission reimbursed

When duplicate anesthesia codes are reported for the same patient on the same date by the same or a different clinician, the Plan will reimburse only the first submission of that code; simultaneous physician and CRNA administration during the same operative session may be reported with appropriate modifiers.

Policy Update History

2025-07-16annual_reviewLatest

Annual review: title revised; grammatical and clarification updates (time and modifier 22); CPT code 01996 added to table for procedure codes allowed for base point units; CPT codes 01991 and 01992 removed; references updated.

2024-02-22ad-hoc_review

Ad-hoc review recorded in policy update history.

2024-02-09annual_review

Annual review recorded in policy update history.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyAnesthesia Information - Professional Provider

Policy CodePolicy CPCP010

Change TypeMaterial revisions including code table updates

Effective DateNovember 1, 2025

Next Review Date

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request; claims are subject to claim review.

SourceLink

On This Page

Modifier 22 (field avoidance) may be appended only when documentation supports substantially greater workbase unit < 5

Documentation must be included in the anesthesia record; applicable when access to the airway is limited, procedure around head/neck/shoulder girdle and/or non‑supine position.

Tumescent anesthesia is included in endovenous ablations and is not separately reimbursable

Payment impactPhysical status modifiers are not utilized to determine payment for anesthesia services

Reference guidanceASA physical status definitions follow American Society of Anesthesiologists and CPT guidelines

Anesthesia modifiers

Purpose of modifiersIdentify whether anesthesia service was personally performed, medically supervised, or under medical direction

Examples of modifiers (performance/supervision/medical direction)AA, QK, QY, QZ, QS, G8, G9, GC, GE, GF

Additional modifiersAlso used: 22 (Increased Procedural Services for field avoidance), 23 (Unusual Anesthesia), 47 (Anesthesia by Surgeon)

Duplicate anesthesia services

DefinitionReporting of the same anesthesia code by the same or different provider for the same patient on the same date of service

Reimbursement rulePlan will only reimburse the first submission of a duplicate anesthesia code on the same date for the same patient

Simultaneous administration noteAnesthesia administration by a physician and a CRNA during the same operative session may be reported with appropriate modifiers

Tumescent anesthesia

DefinitionTumescent anesthesia is a local anesthetic technique used in endovenous ablation procedures

Reimbursement statusTumescent anesthesia is considered included in endovenous ablations and is not separately reimbursable

Billing implicationDo not bill tumescent anesthesia separately for endovenous ablation procedures

Billing Rule

Tumescent anesthesia not separately reimbursable for endovenous ablations

Tumescent anesthesia is considered included in endovenous ablation procedures and is not separately reimbursable.

2023-03-14ad-hoc_review

Ad-hoc review recorded in policy update history.

2022-09-02annual_review

Annual review recorded in policy update history.

2021-09-13new_policy

New policy established.

2021-09-02initial_entry

Initial policy activity noted in update history (listed alongside new policy date).