ModifiedColorado Rocky Mountain Health Plans | UnitedHealthcarePolicy 2026R0032A

Anesthesia Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans and Individual Exchangeopen_in_new

Reimbursement policy for anesthesia services billed on the CMS-1500 form for UnitedHealthcare Commercial and Individual Exchange plans, defining coding, modifiers, time reporting, bundling rules, reimbursement formulas, and billing examples.

Policy Summary

PayerColorado Rocky Mountain Health Plans | UnitedHealthcare

PolicyAnesthesia Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans and Individual Exchangeopen_in_new

Policy CodePolicy 2026R0032A

Change TypeRevisions to bundling, modifiers, reimbursement formulas and obstetric rules

Effective Date

Next Review Date

Key ActionSubmit anesthesia codes with the required anesthesia modifier in the first modifier position and report actual anesthesia time in one-minute increments.

SourceLink

POLICY UPDATE CHANGES

Anesthesia Services Bundled into HCPCS Procedural Codes Section Revised.

Modifiers, Reimbursement Formula, Obstetric Anesthesia Services, Definitions, and Question and Answers Section Revised.

Updated Procedural or Pain Management Codes Bundled into Anesthesia and Procedural or Pain Management Bundled Codes Allowed with Modifiers.

00100-01999Anesthesia CPT code range governed

435Neuraxial labor analgesia time cap (minutes)

Qualifying circumstance codes listed

manyProcedural/pain codes bundled (listed)

AA/AD/QK/QX/QY/QZRequired anesthesia modifiers

Policy summary and scope

Background: UnitedHealthcare aligns its anesthesia reimbursement policy with the American Society of Anesthesiologists (ASA) Relative Value Guide, the ASA CROSSWALK, and CMS guidance including the NCCI Policy Manual and Physician Fee Schedule to define anesthesia reimbursement rules for services billed on the CMS-1500 (CMS 1500) form.

Scope summary: This policy applies to CMS-1500 claims for UnitedHealthcare Commercial and Individual Exchange products and covers coding and submission requirements, required anesthesia modifiers and their percentage adjustments, time reporting in one-minute increments, bundling rules for procedural and pain management services, reimbursement formulas (standard anesthesia formula with and without modifier AD), and specific obstetric exceptions including neuraxial labor analgesia and obstetric add-on code handling.

Claim focus and products: The policy governs anesthesia services submitted on the CMS-1500 form (paper or electronic equivalent) and applies to all UnitedHealthcare Commercial and Individual Exchange benefit plans.

High-level topics covered: required anesthesia CPT code range and exclusions, modifier percentage application (AA, AD, QK, QX, QY, QZ), physical status modifiers (informational only), qualifying circumstances (no additional units), time reporting, multiple/duplicate service rules, procedural/pain management bundling and allowed-with-modifier exceptions, modifier 22 special documentation rule, and obstetric-specific rules including a 435-minute cap on neuraxial labor analgesia and separate time reporting for add-on codes 01968/01969.

Policy header

policy_number2026R0032A

subjectAnesthesia professional reimbursement (CMS 1500)

payerColorado Rocky Mountain Health Plans / UnitedHealthcare

statusMODIFIED

last_review2026-02-15

effective

next_review

Key ActionSubmit anesthesia CPT 00100-01999 with required anesthesia modifier in first position; report actual Anesthesia Time in one-minute increments; follow bundling rules and use modifiers 59/XE/XU or 22 documentation process as applicable

When anesthesia services are reimbursed

Anesthesia services definition and submission

Covered when ALL of the following are met:

ALL of the following

Submitted with an anesthesia CPT code in the range 00100-01999, excluding 01953 and 01996. (CPT codes 01953 and 01996 are not considered anesthesia services for this policy and should not be reported as time-based anesthesia services).
Anesthesia services reported as time-based must include actual Anesthesia Time submitted in one-minute increments (e.g., one hour = 60 minutes).
A required anesthesia modifier must be submitted in the first modifier position to identify personally performed, medically directed, or medically supervised anesthesia (e.g., AA, AD, QK, QX, QY, QZ). UnitedHealthcare will adjust the Allowed Amount by the modifier percentage.

When anesthesia services are reimbursed

Not separately reimbursable when ALL of the following apply:

Reimbursement formulas, modifiers, and thresholds

Reimbursement formulas

Standard anesthesia reimbursement formulas depend on whether modifier AD is reported.

Standard formula without AD: Standard Anesthesia Formula without Modifier AD = ([Base Unit Value + Time Units] x Conversion Factor) x Modifier Percentage

Apply appropriate modifier percentage per modifier table

Standard formula with AD: Standard Anesthesia Formula with Modifier AD = ([Base Unit Value of 3 + 1 Additional Unit if anesthesia notes indicate physician present during induction] x Conversion Factor) x Modifier Percentage

See Modifiers section for AD criteria

Modifier percentage application

Modifier-specific percentage adjustments to the Allowed Amount apply as indicated in the policy.

Code lists and grouped coding guidance

Anesthesia CPT codes (time-based)CPTCovered

00100-01999

Anesthesia services (time-based); 01953 and 01996 excluded when referring to anesthesia services

Excluded anesthesia-like CPT codes (not considered anesthesia services)CPTNot Covered

01953	Not considered anesthesia services (should not be reported as time-based services per ASA RVG)
01996	Daily hospital management — excluded from anesthesia services when referenced; special rules apply for reimbursement

Required anesthesia modifiers and percentagesModifier

AA	100% - Anesthesiologist MD personally performed
AD	100% - Anesthesiologist MD supervising over 4
QK	50% - Anesthesiologist MD supervising 2-4
QX	50% - CRNA or AA directed by Anesthesiologist MD
QY	50% - Anesthesiologist MD supervising 1
QZ	85% - CRNA personally performed

Physical status modifiers (informational)Modifier

P1-P6

Informational only; not considered for additional reimbursement

Qualifying circumstance codes (no additional units)CPT

99100	Qualifying circumstance - no additional units allowed
99116	Qualifying circumstance - no additional units allowed
99135	Qualifying circumstance - no additional units allowed
99140	Qualifying circumstance - no additional units allowed

Procedural or pain management codes bundled into anesthesia servicesmixedNot Covered

0213T-0218T	List includes many T-codes and other procedural codes considered bundled
36415, 36416, 36591, 36592	Examples of bundled vascular access codes
43755, 62320-62327, 64400-64561, 80345, 81001, 81007, 82270-82271, 82800-82810, 85345-85348, 94005, 95941, 99050-99060	Extensive list in policy of codes bundled into anesthesia services

Procedural or pain management bundled codes allowed as distinct with modifiers 59/XE/XUmixedCovered

62321-62327	Allowed as distinct when paired/mapped and modifier 59/XE/XU appended as specified in lists
64400-64561	Many nerve block codes may be distinct with proper modifier per pairing lists
0214T-0218T	Certain T-codes allowed distinct with modifier per mapping lists

Preoperative/Postoperative E/M excluded when same specialtyCPTNot Covered

99091	Excluded if reported by Same Specialty on same date as anesthesia
99202-99499	Excluded (critical care 99291-99292 excluded from this exclusion)
92004-92014	Excluded if reported by Same Specialty on same date as anesthesia

Critical care separate reimbursementCPTCovered

99291-99292

Critical care codes — separately reimbursable (not included in anesthesia)

HCPCS/HCPCS-to-anesthesia mappingsmixedNot Covered

G0105, G0121, G0186, G0268, G0339, G0340, G0341-0343, G0412-G0415, G0428-G0429, G0448, G0516-G0518	HCPCS codes with mapped anesthesia CPT codes listed in policy
S0601, S0800, S0810, S0812, S2053-S2061, S2065-S2070, S2079-S2095, S2102-S2118, S2205-S2209, S2225-S2348, S2350-S2405, S4028	Numerous S-codes mapped to anesthesia CPT codes in policy

Anesthesia add-on codes (obstetric)CPTCovered

01967	Neuraxial labor analgesia/anesthesia for planned vaginal delivery — reimbursed with cap of 435 minutes
01968	Obstetric add-on (c-section) — may be reimbursed when billed with 01967; time reported separately
01969	Obstetric add-on (c-section) — may be reimbursed when billed with 01967; time reported separately

Billing, documentation, and reporting requirements

Billing Rule

Submit anesthesia codes with required modifier in first position

All anesthesia services must be submitted with a required anesthesia modifier in the first modifier position to identify performance/direction level. The Allowed Amount will be adjusted by the modifier percentage.

Billing Rule

Report anesthesia time in one-minute increments

Time-based anesthesia services must be reported with actual Anesthesia Time in one-minute increments.

Key terms

Definitions

Anesthesia TimeBegins when the Anesthesia Professional prepares the patient for induction of anesthesia in the operating room or equivalent area and ends when the Anesthesia Professional is no longer in personal attendance.

Same Individual Physician or Other QHPThe same individual rendering health care services reporting the same Federal Tax Identification number.

Same Specialty Physician or Other QHPPhysicians and/or Other QHPs of the same group and same specialty reporting the same Federal Tax Identification number.

Standard Anesthesia FormulaEither the Standard Anesthesia Formula with Modifier AD or without Modifier AD as described: without AD = ([Base Unit Value + Time Units] x Conversion Factor) x Modifier Percentage; with AD uses base value of 3 plus possible additional unit for presence during induction.

Frequently asked questions

Unsupported block type: paragraph

Note

Policy changes and effective dates

2025-03-30revised

Updated Procedural or Pain Management Codes Bundled into Anesthesia and Procedural or Pain Management Bundled Codes Allowed with Modifiers.

2025-10-01revised

Modifiers, Reimbursement Formula, Obstetric Anesthesia Services, Definitions, and Question and Answers sections revised.

2026-02-15revisedLatest

Anesthesia Services Bundled into HCPCS Procedural Codes section revised (HCPCS procedural code bundling updates).

Policy Summary

PayerColorado Rocky Mountain Health Plans | UnitedHealthcare

PolicyAnesthesia Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans and Individual Exchangeopen_in_new

Policy CodePolicy 2026R0032A

Change TypeRevisions to bundling, modifiers, reimbursement formulas and obstetric rules

Effective Date

Next Review Date

Key ActionSubmit anesthesia codes with the required anesthesia modifier in the first modifier position and report actual anesthesia time in one-minute increments.

SourceLink

On This Page

title":"Anesthesia and procedural bundling","type":"criteria_group"},{

citations":[],"intro":"Covered or allowed only when ANY of the following apply:","nodes":["{\"operator\":\"any\",\"children\":[{\"text\":\"A procedural or pain management CPT/HCPCS code that would otherwise be bundled is reported with an appropriate modifier to indicate a distinct procedural service (for example, modifier 59 or the CMS RTM modifiers XE, XP, XS, XU when their use is supported by documentation).\"},{\"text\":\"Specific paired code lists (as referenced by UnitedHealthcare) identify CPT/HCPCS codes that may be considered separate when appended with modifier 59/XE/XP/XS/XU. Providers should append the modifier in accordance with coding guidance and retain documentation to support the distinct service.\"},{\"note\":\"Use of modifier must be supported by documentation; inappropriate modifier use may result in denial or CCI edit application.\"}]}"],"title":"Bundled codes allowed with modifiers","type":"criteria_group"},{"citations":[],"intro":"Not reimbursed when ALL of the following are met:","nodes":["{\"operator\":\"all\",\"children\":[{\"text\":\"Evaluation and management (E/M) services reported on the same date of service as anesthesia are not separately reimbursable when reported by the Same Specialty as the anesthesia provider.\"},{\"text\":\"Critical care services (CPT 99291-99292) are an exception and are separately reimbursable when appropriately reported and documented.\"},{\"note\":\"When E/M services are reported by a different specialty or as distinct and fully documented services meeting regulatory guidance, separate reimbursement may be considered.\"}]}"],"title":"Pre/postoperative E/M services","type":"criteria_group"},{"citations":[],"intro":"Covered when ALL of the following are met:","nodes":["{\"operator\":\"all\",\"children\":[{\"text\":\"CPT code 01996 (daily hospital management of acute pain) is reimbursable once per date of service, except it is excluded on the day of insertion of an indwelling catheter when performed in specified places of service as described in applicable guidance.\"},{\"text\":\"If the same individual provides both daily hospital management (01996) and pain management services, 01996 is considered included in the pain management service and not separately reimbursable.\"},{\"note\":\"Refer to the Obstetric Anesthesia and Anesthesia Services sections for additional rules and exceptions related to add-on codes.\"}]}"],"title":"Daily hospital management (01996)","type":"criteria_group"},{"citations":[],"intro":"Covered when ALL of the following are met:","nodes":["{\"operator\":\"all\",\"children\":[{\"text\":\"Neuraxial labor analgesia (CPT 01967) reimbursement is based on the Base Units plus time units calculated using actual anesthesia time, subject to a maximum total anesthesia time unit cap equivalent to 435 minutes of anesthesia time (per policy limits).\"},{\"text\":\"Associated add-on codes 01968 and 01969 are reported for subsequent encounters or continued management per CPT guidance; time reporting for these add-on codes must follow ASA/CPT rules and UnitedHealthcare time-reporting policy.\"},{\"note\":\"Total reported units for 01967 (base + time) will not exceed the policy's maximum; ensure proper use of add-on codes and time documentation.\"}]}"],"title":"Neuraxial labor analgesia (01967) rules","type":"criteria_group"},{"citations":[],"intro":"When multiple anesthesia services are reported, apply the following rules:","nodes":["{\"operator\":\"all\",\"children\":[{\"text\":\"When multiple surgical procedures occur during a single anesthesia administration, report only the single anesthesia code with the highest Base Unit Value; report combined total anesthesia time for all procedures on the same date of service by the same or different physicians/Other QHPs.\"},{\"text\":\"Add-on anesthesia codes (01953, 01968, 01969) are exceptions to the single-code rule and may be reported in addition to the primary anesthesia code when CPT guidance allows.\"},{\"text\":\"Duplicate (identical) anesthesia codes reported by the same or different provider on the same date of service will be reimbursed only once — the first submission.\"},{\"text\":\"Anesthesia administration services provided simultaneously by an MD and a CRNA during the same operative session may each be reimbursed at 50% of the Allowed Amount when appropriately reported with modifiers QK/QY and QX.\"},{\"text\":\"If an additional anesthesia administration occurs during a different operative session on the same day, one additional anesthesia administration may be reimbursed when appended with modifier 59, 76, 77, 78, 79 or XE; as with the initial administration, report only the single anesthesia code with the highest Base Unit Value for that session.\"}]}"],"title":"Multiple/duplicate anesthesia services","type":"criteria_group"}],

id':'coverage-rules

label':'COVERAGE

title':'When anesthesia services are reimbursed' } I noticed problems in your JSON: keys use single quotes and embedded JSON strings malformed. Please produce valid JSON only.

AA and AD: AA = 100% and AD = 100% Allowed Amount (Anesthesiologist personally performed or supervising over 4)

QK/QX/QY: QK = 50%, QX = 50%, QY = 50% (medical direction/CRNA direction/supervision levels)

UnitedHealthcare applies percent reductions for percent-of-charge contracts as described

QZ = 85% (CRNA personally performed)

Physical status modifiers

Physical status modifiers and several other modifiers are informational and generally do not entitle the provider to additional reimbursement.

P1-P6 informational: Physical status modifiers P1-P6 may be reported but are informational only and not considered for additional reimbursement

Consistent with CMS

Other modifiers not reimbursed: Modifiers 23, 47 and HCPCS modifiers GC, G8, G9, QS do not allow additional reimbursement above the usual fee; modifier 22 has a specific special rule

Modifier 22 special rule

Modifier 22 may qualify for additional base units only when all specified conditions and documentation requirements are met.

Modifier 22 eligibility criteria: All required conditions must be met: Base Unit Value less than 5 units; modifier 22 appended for unusual positioning and field avoidance; supporting documentation submitted (paper claim with requested documentation)Base Unit Value < 5

Submit paper CMS form with documentation

Modifier 22 payment outcome: If approved, additional base units are added so total base units = 5 and applied within the Standard Anesthesia FormulaTotal base units set to 5 if approved

Services with base unit >=5 already account for positioning

Numeric thresholds

Neuraxial labor analgesia cap435 minutes

Modifier 22 Base Unit adjustment thresholdBase Unit Value < 5 (additional units added so total base units = 5 if approved with documentation)

Paper claims: report minutes in field 24G
Electronic claims: map minutes to SV104 Service Unit Count

Billing Rule

Bundled services modifier requirement

Certain procedural or pain management services that would otherwise be bundled into anesthesia may be reported as distinct only when an appropriate modifier is appended to the procedural code per the policy's paired code lists.

Modifiers to append: 59, XE, XU
See policy paired code lists for specific allowed code mappings

Documentation Required

Modifier 22 supporting documentation

Modifier 22 may qualify for additional reimbursement only when all criteria are met. For anesthesia services with a Base Unit Value less than 5, submit supporting documentation via a paper claim (CMS form) when requesting additional reimbursement; if approved, additional base units are added so total base units = 5 within the Standard Anesthesia Formula.

Billing Rule

Duplicate code reimbursement limitation

When duplicate (same) anesthesia codes are reported by the same or different provider for the same patient and date of service, only the first submission will be reimbursed. Exception: simultaneous anesthesia administration by an MD and a CRNA during the same operative session may each be reimbursed (using appropriate modifiers) at the percentages indicated in the modifier table.

Only first submission reimbursed for duplicate codes
Simultaneous MD and CRNA: report QK or QY and QX to allow split reimbursement

Billing Rule

Daily hospital management reporting for 01996

CPT 01996 (daily hospital management of epidural/subarachnoid drug administration) is reimbursable once per date of service, excluding the day of insertion, when provided in CMS places of service 19, 21, 22 or 25. CPT 01996 is included in the pain management procedure if submitted on the same date by the Same Individual Physician or Other QHP.

POS allowed: 19, 21, 22, 25
Reimbursed once per date (exclude insertion day)
Included (not separately reimbursed) when submitted same date by Same Individual

Billing Rule

Obstetric add-on time reporting

When obstetric add-on codes 01968 or 01969 are billed with primary neuraxial labor analgesia code 01967, the add-on time must be reported separately and is not added to the labor anesthesia time. 01967 reimbursement is subject to a cap of 435 minutes.

Report add-on code time separately when billed with 01967
Do not add add-on time to labor anesthesia time; 01967 capped at 435 minutes

Billing Rule

Pre/post op E/M exclusion

Preoperative and postoperative E/M services are not separately reimbursable when reported by the Same Specialty Physician or Other QHP on the same date as an anesthesia service. This exclusion covers CPT codes 99091, 99202-99499 (except critical care 99291-99292) and 92004-92014. Critical care codes 99291-99292 remain separately reimbursable.

Excluded E/M ranges: 99091, 99202-99499 (except 99291-99292), 92004-92014
Exception: critical care codes 99291-99292 are separately reimbursable