CurrentBlue Cross Blue Shield - South CarolinaPolicy N/A

Anesthesia services billing and reimbursement

Governs how Blue Cross Blue Shield of South Carolina and BlueChoice HealthPlan reimburse anesthesia and monitored anesthesia care services, applicable to anesthesiologists and certified registered nurse anesthetists (CRNAs) filing CPT anesthesia codes for covered surgical and diagnostic services.

Policy Summary

PayerBlue Cross Blue Shield - South Carolina

PolicyAnesthesia services billing and reimbursement

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionFile claims using CPT anesthesia codes and apply the appropriate anesthesia modifiers recognized by the payer.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

15-mintime unit increment

nearest tenthrounding

includednerve blocks

physician-onlyrisk modifiers

physician onlyMAC reimbursement

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.

Anesthesia Coverage Rules

Anesthesia coverage rules

Covered when the following conditions and limitations are met:

General anesthesia covered when requested by the operating physician and performed by a nurse anesthetist or physician other than the operating physician for covered surgical services.

Anesthetic or sedation performed by the operating physician as part of the surgical or diagnostic procedure is covered; local anesthesia is considered integral to the surgical procedure and is not separately reimbursed.

Monitored anesthesia care (MAC) modifiers QS, G8, and G9 may be reimbursed only when a physician personally performs the procedure (modifier AA) and medical necessity criteria are met; MAC provided by CRNAs (QK, QX, QY, QZ) will not be reimbursed.

Risk modifiers (P3–P5) are reimbursed only when the physician (modifier AA) administers the anesthesia personally; there is no separate reimbursement for these risk modifiers for CRNAs or for physician supervision of CRNAs.

Administration of a nerve block is included in the allowance for total anesthesia time and is not separately reimbursed unless billed as a separate procedure for treatment of a nonsurgical condition or nonpostoperative pain management.

Maternity epidural anesthesia is reimbursed as a global allowance without time units; report appropriate epidural delivery codes per billing guidance.

See provider actions for exact maternity epidural billing codes.

Standby anesthesia may be reimbursed when the anesthesiologist provides personal patient care (even if not administering anesthesia); in such cases bill the appropriate anesthesia code, modifier and time units.

Exclusions: No anesthesia benefits for administration with noncovered services (e.g., cosmetic surgery). No separate benefits when in conjunction with other services for preoperative anesthesia consultation, transesophageal cardiography, emergency intubation, anesthesia administered by the attending surgeon or surgical assistant, or local anesthesia.

Anesthesia Coding and Time Units

Recognized anesthesia modifiers and MAC codesCPT

AA	Anesthesia services performed personally by an anesthesiologist (includes reimbursement of an employed CRNA)
AD	Medical supervision by physician; more than four concurrent anesthesia procedures
QK	Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals
QX	CRNA service with medical direction by a physician
QZ	CRNA service without medical direction by physician
G8	MAC for a deep complex, complicated or markedly invasive surgical procedure
QS	Monitored anesthesia care service
G9	MAC for patient with severe cardiopulmonary condition

Anesthesia risk modifiersCPT

P3	Risk modifier: Add one time unit when a patient has a severe systemic disease
P4	Risk modifier: Threat to life, such as severe respiratory or cardiac disease
P5	Risk modifier: Add three time units when the patient is not expected to survive 24 hours

Maternity epidural anesthesia procedure codesCPT

01967	Obstetrical epidural administration for normal delivery
01968	Obstetrical epidural administration for cesarean section (used in conjunction with 01967)

Time unit calculation

Time unit incrementUnits are calculated per 15-minute increment for claims adjudication.

Reporting unitsProviders should report anesthesia time in minutes; the payer converts minutes to time units.

Rounding ruleCalculated units are rounded to the nearest tenth (1/10).

Claim Filing, Modifiers, and Special Billing

Billing Rule

Claim filing and modifiers

File claims using CPT anesthesia codes. Physicians and CRNAs must use the appropriate anesthesia modifiers recognized by the payer when billing anesthesia services.

Use CPT anesthesia codes for all anesthesia claims
Apply payer-recognized anesthesia modifiers as appropriate

Billing Rule

Maternity epidural billing

BlueCross and BlueChoice reimburse maternity epidural anesthesia as a global allowance with no consideration of time units. The practitioner who inserts the epidural needle generally files for the total service using modifier AA. If the physician and CRNA have an arrangement to both bill for the epidural, the physician should bill with modifier QK or QY and the CRNA should bill with modifier QX. Physicians should report CPT code 01967 for obstetrical epidural administration for a normal delivery, and both CPT codes 01967 and 01968 when performing a cesarean section. Do not report these codes for 'standing by' when the patient elects natural childbirth and no epidural is performed.

Key Definitions

Conscious sedation — definition and clinical description

Benefit inclusionBenefits for conscious sedation are generally included in medical care consultations or surgical care, including preoperative and postoperative care.

Pediatric reimbursementBlueCross may provide reimbursement for conscious sedation when the patient is under 13 years of age.

Base units

Basis for proceduresMedicare base units are used as the basis for anesthesia procedures.

Use in payment calculationBase units form the foundation to which time units and applicable modifiers are added for reimbursement calculations.

Filing requirementClaims must be filed using CPT anesthesia codes; recognized modifiers are applied to base units as appropriate.