ModifiedBlue Cross Blue Shield - TexasPolicy N/A

Anesthesia Pay And Bill V2

Billing and reimbursement rules for anesthesia services for BCBSTX, including time unit calculation, modifier-specific maximum allowable fees, obstetrical anesthesia point caps, bundling rules for ventilator management, and treatment of select epidural/injection CPT codes.

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyAnesthesia Pay And Bill V2

Policy CodePolicy N/A

Change TypeRevised (04/09/2025)

Effective Date

Next Review Date

Key ActionPopulate units field 24G on the CMS-1500 with the number of minutes actually spent on the procedure (e.g., 90 for 1 hour 30 minutes).

SourceLink

POLICY UPDATE CHANGES

Policy revised 04/09/2025.

32Max combined OB points for 01967 + add-ons

23OB vaginal max points

$325.52QY,2 fee

$310.01QK,2 fee

$162.76AD,2 fee

Policy overview

Blue Cross Blue Shield - Texas; Anesthesia Pay And Bill V2 — Supplementary guidance to CPCP010: Anesthesia Information. This policy provides billing rules for anesthesia time calculation (report minutes in CMS-1500 units field 24G and convert minutes to time units), modifier-specific reimbursement limits for MD supervision/medical direction of CRNA/AA (QY/QK/AD with specified maximums), obstetrical anesthesia point maximums including combined limits when 01967 is billed with 01968/01969, bundling and denial rules for ventilator management codes 94656/94657 when provided with anesthesia or same-day E/M services, and classification of injection/epidural codes 62310/62311/62318/62319 as surgical (type of service = 2).

Key thresholds and review dates

Time unit conversion15 minutes = 1 time unit; time units rounded to the tenth (e.g., 49 minutes = 3.26 → 3.3). Units field 24G should reflect minutes (e.g., 90).

OB Vaginal delivery maximum points23 total maximum allowable points.

OB Cesarean delivery maximum points32 total maximum allowable points.

Combined OB 01967 + add-ons limitWhen 01967 is billed with 01968 and/or 01969, BCBSTX allows a combined maximum of 32 points.

Last review date2025-04-09

Effective date

Next review date

Coverage & classification rules

Treatment of Codes 62310, 62311, 62318 and 62319

The following rules apply to CPT codes 62310, 62311, 62318 and 62319.

Codes 62310, 62311, 62318 and 62319 are classified as surgical services; claims should reflect a Type of Service = 2.

BCBSTX will reimburse these codes at the current maximum allowable as determined by BCBSTX.

Time Unit Calculation: Time units are determined by the total time in minutes actually spent performing the procedure. Fifteen minutes = 1 time unit; time units are rounded to the tenth (e.g., 49 minutes = 3.3 time units). The Units field (24G) of the CMS-1500 should reflect the number of minutes the provider spent on the procedure (e.g., 90 minutes = 90 in the units field).

Ensure the minutes reported in the units field match documentation; incorrect reporting may result in claim processing delays or denials.

Code lists and coding guidance

Anesthesia OB primary and add-on codesCPTCovered

01967	Primary OB delivery anesthesia procedure (referenced in policy)
01968	OB anesthesia add-on code
01969	OB anesthesia add-on code

Ventilation managementCPTNot Covered

94656	Ventilation management — denied if reported same day, same patient, by same provider as an anesthesia procedure (within first 24 hours)
94657	Subsequent ventilation management — not payable separately when billed same day as an E/M service (even with modifier 25)

Epidural/injection procedures classified as surgicalCPTCovered

62310	Epidural injection — classified as surgical service (type of service = 2)
62311	Epidural injection — classified as surgical service (type of service = 2)
62318	Epidural injection — classified as surgical service (type of service = 2)
62319	Epidural injection — classified as surgical service (type of service = 2)

Anesthesia modifiers and allowed feesmixedCovered

QY	Modifier QY - MD Medical Direction of a CRNA/AA; fee structure referenced as QY,1 and QY,2 ($325.52 for QY,2)
QK	Modifier QK - MD Medical Direction of a CRNA/AA; QK,2 = $310.01
AD	Modifier AD - MD supervision of a CRNA/AA; AD,2 = $162.76

For operational coding: the CMS-1500 units field 24G must reflect the number of minutes actually spent on the procedure (for example, report 90 for one hour 30 minutes). Time units are calculated from actual minutes with 15 minutes = 1 time unit, and time units are rounded to the tenth (e.g., 49 minutes = 3.26 → 3.3 time units).

Billing and provider-impact rules

Billing Rule

Report minutes in CMS-1500 units field 24G

Populate the CMS-1500 form field 24G with the number of minutes actually spent performing the procedure (for example, report 90 for one hour 30 minutes).

Example: 1 hour 30 minutes → enter 90 in field 24G

Billing Rule

Round time units to the tenth

Calculate anesthesia time units from total minutes (15 minutes = 1 unit) and round time units to the tenth. Follow the rounding example when converting minutes to units.

15 minutes = 1 time unit
Rounding example: 49 minutes → 3.26 → 3.3 time units

Denial Risk

Do not bill ventilation management with anesthesia within 24 hours

Do not bill CPT 94656 for ventilator management if the same provider billed an anesthesia procedure for the same patient on the same day; such claims will be denied because ventilation management within the first 24 hours is part of the global anesthesia service.

Affected code: 94656
Denial condition: reported same day, same patient, by the same provider as an anesthesia procedure (within first 24 hours)

Denial Risk

Do not separately bill 94657 with E/M same day

Do not expect separate payment for CPT 94657 when it is billed on the same day as an evaluation and management (E/M) service — it is considered part of the E/M service even if modifier 25 is appended.

Affected code: 94657
Note: Modifier 25 on the E/M does not permit separate payment for 94657 when billed same day

Billing Rule

Set type of service for codes 62310/62311/62318/62319

Claims for CPT codes 62310, 62311, 62318 and 62319 should be submitted with Type of Service = 2 (surgical).

Set Type of Service = 2 (surgical) for codes 62310, 62311, 62318, 62319

Billing Rule

Apply modifier-specific maximum allowable fees

When billing MD medical direction or supervision of a CRNA/AA using modifiers QY, QK or AD, apply the specified BCBSTX maximum allowable fees for the modifier-specific level.

QY,2 = $325.52 (MD medical direction)
QK,2 = $310.01 (MD medical direction)
AD,2 = $162.76 (MD supervision)

Obstetrical anesthesia point caps and reimbursement

Obstetrical Anesthesia Points (OB Time and Points Maximum Allowable Points)

OB Point Maximums

Vaginal delivery maximum: Obstetrical Vaginal delivery: 23 total maximum allowable points.23 points
Cesarean delivery maximum: Obstetrical Cesarean delivery: 32 total maximum allowable points.32 points
General anesthesia: If general anesthesia is used for any obstetrical Vaginal or Cesarean delivery, the maximum allowable points remain applicable.
Reimbursement when actual points lower: If total actual points are less than the total maximum allowable points, reimbursement will be based on total actual points.
Reimbursement for OB add-on codes: When primary OB delivery anesthesia procedure (01967) is billed with either 01968 and/or 01969, BCBSTX allows a combined maximum of 32 points.combined maximum 32 points

OB numeric thresholds

OB Vaginal delivery maximum points23 total maximum allowable points.

OB Cesarean delivery maximum points32 total maximum allowable points.

Combined 01967 + add-ons (01968/01969) capCombined maximum = 32 points (HIGHLIGHT: 32-point cap).

Ventilator management bundling rules

Ventilator Management in Conjunction with Anesthesia

Ventilator Management with Anesthesia/E/M

94656 with anesthesia within 24 hours: Ventilation management billed on the same day as an anesthesia procedure is part of the global anesthesia service for the first 24 hours after anesthesia induction and is not billable. If procedure code 94656 is reported on the same day, on the same patient, by the same provider as an anesthesia procedure, the ventilation management service (94656) will be denied.within first 24 hours
94657 with same-day E/M: Subsequent ventilation management (94657) billed on the same day as an evaluation and management service is considered part of the E/M service and is not payable separately even if the E/M service is billed with modifier 25.same day as E/M
Unusual postoperative respiratory problems: If the patient develops unusual postoperative respiratory problems requiring reintubation and/or ventilation management, report the service with critical care or the appropriate evaluation and management code(s).

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyAnesthesia Pay And Bill V2

Policy CodePolicy N/A

Change TypeRevised (04/09/2025)

Effective Date

Next Review Date

Key ActionPopulate units field 24G on the CMS-1500 with the number of minutes actually spent on the procedure (e.g., 90 for 1 hour 30 minutes).

SourceLink

On This Page

OpenPayer

Anesthesia Pay And Bill V2

Policy overview

Coverage & classification rules

Code lists and coding guidance

Billing and provider-impact rules

Obstetrical anesthesia point caps and reimbursement

Ventilator management bundling rules

Definitions

Policy revisions