CurrentBlue KCPolicy POL-PP-102

Anesthesia Processing

Defines billing, reimbursement, and payment integrity rules for anesthesia services (including general, regional, MAC, PCA, sedation, intubation/ventilation, nerve blocks, and related services) for Blue KC lines of business. Applies to professional and facility providers and addresses code reporting, inclusions/exclusions, modifiers, and time unit rules.

Policy Summary

PayerBlue KC

PolicyAnesthesia Processing

Policy CodePolicy POL-PP-102

Change TypeAnnual review (07/01/2025)

Effective DateJul 1, 2019

Next Review DateJul 1, 202626d

Key ActionDo not bill anesthesia separately when the performing surgeon/physician also provides the anesthesia; such claims will be denied.

SourceLink

POLICY UPDATE CHANGES

Annual review- information added on multiple anesthesia procedures for same patient, same date of service, and NCCI guidelines on Standard Preparation/Monitoring Services for Anesthesia, and Anesthesia Service Included in the Surgical Procedure.

00100-01999Anesthesia code range governed

01960/01961/01967/01996/31500/99360Key codes highlighted

MultipleLOBs impacted (Commercial, Medicare Advantage, ACA, Small Group, FEP)

Policy summary

This policy provides payment integrity guidance to align anesthesia billing and reimbursement with industry standards including CPT, CMS, the AMA, and the NCCI; it defines billing rules for anesthesia services and related procedures. It applies to professional and facility providers across Blue KC lines of business (including Commercial, Blue Medicare Advantage, ACA, Small Group, FEP) and covers general, regional, MAC, PCA, sedation, intubation/ventilation, nerve blocks, and related services. Final payment is determined by date of service, member eligibility and benefits, the Provider Service Agreement, and results of claims adjudication and standard edits—so inclusion in this guidance does not guarantee payment.

Coverage & reimbursement criteria

Local anesthesia

Local anesthesia inclusion: Local anesthesia (direct infiltration, digital block, topical) is an integral part of the surgical procedure and no separate or additional reimbursement will be allowed.

Stand-by anesthesia (99360)

Stand-by anesthesia coverage: Stand-by anesthesia services where there is no direct patient contact (physician available in immediate area) are not eligible for coverage even when required by the facility.

Code lists and status

Primary anesthesia CPT/HCPCS codes referencedCPTCovered

00100-01999	Range of primary anesthesia CPT codes for operative procedures
01960	Anesthesia for vaginal delivery (general) - 5 ASA units
01961	Anesthesia for cesarean delivery (general) - 7 ASA units
01967	Continuous epidural analgesia for labor (vaginal delivery)
01968	Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia
01969	Cesarean hysterectomy following neuraxial labor analgesia/anesthesia
01996	Anesthesia for patient-controlled analgesia pump management
01999	Unlisted anesthesia procedure
31500	Intubation, endotracheal, emergency or when billed independently of anesthesia time

Regional nerve block CPT codesCPTCovered

64400	Nerve block; trigeminal division, anesthesia
64402	Nerve block; facial nerve
64405	Nerve block; other peripheral nerves
64408	Nerve block; other, single shot
64410	Nerve block; continuous infusion
64412	Peripheral nerve or branch block
64413	Peripheral nerve block, continuous infusion
64415	Injection, anesthetic agent; peripheral nerve

Patient Controlled Analgesia and related codesCPTCovered

01996	Anesthesia for patient-controlled analgesia pump management
62350	Injection(s), diagnostic or therapeutic agent, spinal; lumbar or sacral, single or initial
62351	Each additional lumbar or sacral segment
62360	Injection(s), therapeutic agent, epidural; lumbar or sacral
62361	Each additional lumbar or sacral segment
62362	Each additional thoracic or cervical segment
36557	Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older
36558	Insertion of peripherally inserted central venous catheter (PICC)
36560	Insertion of tunneled centrally inserted central venous catheter
36561	Exchange of tunneled or non-tunneled centrally inserted central venous catheter

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Moderate (conscious) sedation codes (examples)CPT

99151	Moderate sedation services provided by the same physician performing the diagnostic or therapeutic service, initial 15 minutes
99152	Moderate sedation provided by an independent physician, initial 15 minutes
99153	Moderate sedation provided by an independent physician, each additional 15 minutes

Standby anesthesiaCPTNot Covered

99360

Prolonged services in the office or other outpatient setting requiring prolonged physician service — sometimes used to report standby anesthesia; considered not covered/denial risk when billed as separate anesthesia service

Key definitions

Field avoidanceWhen an anesthesiologist does not have direct access to the patient's airway during surgery; charges for field avoidance will not be reimbursed.

Monitored Anesthesia Care (MAC)An anesthesia technique using sedatives where the patient remains responsive and breathes without assistance; the anesthesiologist or CRNA must be continuously present, prepared to convert to general anesthesia, and MAC is reported and reimbursed at the same level as general or regional anesthesia.

Document changes

2025-07-01revisionLatest

Annual review — added guidance on multiple anesthesia procedures same day (bill based on procedure with highest base unit; combined total anesthesia time; additional same-day anesthesia billed for same patient denied), added NCCI guidance on Standard Preparation/Monitoring Services for Anesthesia (preparation/monitoring not separately reportable unless prior/unrelated or after postoperative care; use modifiers 59, XE, XU), and reiterated that anesthesia service may be included in the surgical procedure (no separate payment when same physician furnishes both).