CurrentColorado Rocky Mountain Health PlansPolicy N/A

Anesthesia Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Planopen_in_new

Defines UnitedHealthcare Community Plan Medicaid reimbursement rules for professional anesthesia services (CPT 00100-01999 excluding 01953 and 01996) including time reporting, modifiers, bundling rules, formulas, qualifying circumstances, duplicate/multiple services, state exceptions, and billing guidance for CMS-1500/837P claims.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyAnesthesia Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Planopen_in_new

Policy CodePolicy N/A

Change TypeRevisions and state exceptions updates (multiple)

Effective Date

Next Review Date

Key ActionSubmit anesthesia services with CPT 00100-01999 (excluding 01953 and 01996) using a 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 updated.

Annual review version update and history archived entries prior to 2/1/2024.

State Exceptions: Idaho added.

State Exceptions: California removed.

Reimbursement Guidelines: Procedural or Pain Management Codes Bundled into Anesthesia and Procedural or Pain Management Bundled Codes Allowed with Modifiers table updated.

State Exceptions: Wisconsin updated (multiple entries).

State Exceptions: Indiana updated.

Reimbursement Formula section updated and multiple state exceptions updated.

Policy implemented by UnitedHealthcare Community & State.

1Anesthesia CPT range defined

Policy overview

This policy aligns UnitedHealthcare Community Plan Medicaid anesthesia reimbursement with the ASA Relative Value Guide (RVG®), the ASA CROSSWALK®, the CMS NCCI Policy Manual, CMS NCCI edits, and the CMS National Physician Fee Schedule. It defines code and modifier usage, time reporting requirements, bundling and crosswalk rules, reimbursement formulas, and notes state-specific exceptions that may alter modifier percentages or coverage. The anesthesia CPT range in-scope is 00100-01999 with 01953 and 01996 specifically excluded from anesthesia time-based reporting; the policy focuses on high-level professional reimbursement and bundling guidance for anesthesia services.

High-level policy items

scope_summaryDefines UnitedHealthcare Community Plan Medicaid reimbursement rules for professional anesthesia services (CPT 00100-01999 excluding 01953 and 01996) including time reporting, modifiers, bundling rules, formulas, qualifying circumstances, duplicate/multiple services, state exceptions, and billing guidance for CMS-1500/837P claims.

subjectAnesthesia professional reimbursement

statusCURRENT

payerColorado Rocky Mountain Health Plans

policy_titleAnesthesia Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan

effective_date

has_material_changetrue

Anesthesia time reporting increment1 minute increments

01996 frequencyOnce per date of service excluding day of insertion

Claim reporting unitsReport anesthesia services as minutes; units only when code description includes a time period

Anesthesia coverage and reporting criteria

Anesthesia Services Reporting and Reimbursement Rules

Covered when ALL of the following are met:

ALL of the following

Anesthesia services are reported with a CPT anesthesia code in the range 00100-01999, excluding 01953 and 01996; codes 01953 and 01996 are not considered time-based anesthesia services according to the ASA RVG®.
Anesthesia services are reimbursed as time-based using the Standard Anesthesia Formula; time must be reported in one-minute increments consistent with CMS guidelines (e.g., 60 minutes = 60).
All anesthesia services, including Monitored Anesthesia Care, must be submitted with a required anesthesia modifier in the first modifier position identifying whether the service was personally performed, medically directed, or medically supervised; Allowed Amounts are adjusted by the modifier percentage.

Reimbursement formulas, modifiers, and percentages

Reimbursement Formulas

Standard Anesthesia Formula used for time-based reimbursement:

Standard formulas

Without AD: Standard Anesthesia Formula without Modifier AD: ([Base Unit Value + Time Units + Modifying Units] x Conversion Factor) x Modifier Percentage
With AD: Standard Anesthesia Formula with Modifier AD: ([Base Unit Value of 3 + 1 Additional Unit if anesthesia notes indicate the physician was present during induction] x Conversion Factor) x Modifier Percentage
Document physician presence during induction to justify additional unit when AD is used

Modifier-based Reimbursement Percentages

Modifiers determine reimbursement percentage adjustments to the Allowed Amount; consistent with CMS and state exceptions:

Code lists and coding rules

Anesthesia CPT codes considered anesthesia servicesCPTCovered

00100-01999

Anesthesia CPT code range (01953 and 01996 excluded as anesthesia services)

Excluded from anesthesia service categorizationCPTNot Covered

01953	Not considered an anesthesia service for time-based reporting per ASA RVG
01996	Not considered an anesthesia service for time-based reporting per ASA RVG (daily hospital management handled specially)

Qualifying circumstance codes (no additional base units allowed)CPT

99100	Qualifying circumstance
99116	Qualifying circumstance
99135	Qualifying circumstance
99140	Qualifying circumstance

Required anesthesia modifiers (first modifier position)Modifier

AA	Anesthesiologist personally performed; 100% reimbursement
AD	Medical supervision of more than four concurrent anesthesia procedures; 100% reimbursement (state exceptions may vary)
QK	Medical direction of CRNA; 50% reimbursement
QX	CRNA service with medical direction; 50% reimbursement
QY	Medical direction of one or more CRNAs by an anesthesiologist; 50% reimbursement
QZ	CRNA service without medical direction; 100% reimbursement

Altered circumstance modifiers that do not increase reimbursementModifier|HCPCS

23	Unusual anesthesia (CPT altered circumstance) - no additional reimbursement
47	Anesthesia by same physician performing procedure - no additional reimbursement
GC	HCPCS - no additional reimbursement
G8	Monitored anesthesia care - no additional reimbursement above usual fee
G9	Monitored anesthesia care - no additional reimbursement above usual fee
QS	Monitored anesthesia care - no additional reimbursement above usual fee

Procedural or Pain Management Codes Bundled into Anesthesia (sample entries from table)mixedNot Covered

0213T	Listed in bundled table (multiple cross-references to T-codes and others)
43755	Listed as bundled with various codes (see policy table for mapping)
62320	Included in bundled procedural/pain management list
64400	Included in bundled procedural/pain management list
64415	Included in bundled procedural/pain management list
36415	Included in bundled procedural/pain management list
36591	Included in bundled procedural/pain management list
80345	Included in bundled procedural/pain management list
81001	Included in bundled procedural/pain management list

Anesthesia services bundled in HCPCS procedural codes (sample mappings)HCPCS|CPTNot Covered

G0104	Mapped to anesthesia CPT codes (e.g., S0810, 00812, 00140, etc.) per table
G0105	Mapped per table
G0121	Mapped per table
G0186	Mapped per table
G0268	Mapped per table
G0339	Mapped per table

Epidural/Subarachnoid injection CPT codes allowed separately with modifierCPTCovered

62320	Epidural or subarachnoid injection of diagnostic or therapeutic substances; cervical or thoracic
62321	Epidural or subarachnoid injection of diagnostic or therapeutic substances; cervical or thoracic, diagnostic or therapeutic, with imaging guidance
62322	Epidural or subarachnoid injection of diagnostic or therapeutic substances; lumbar or sacral (caudal)
62323	Epidural or subarachnoid injection of diagnostic or therapeutic substances; lumbar or sacral (caudal), diagnostic or therapeutic, with imaging guidance
62324	Epidural or subarachnoid injection of diagnostic or therapeutic substances; lumbar or sacral, repeat
62325	Epidural or subarachnoid injection of diagnostic or therapeutic substances; other specified
62326	Epidural or subarachnoid injection; other specified
62327	Epidural or subarachnoid injection; other specified, with imaging guidance

Modifiers referenced for distinct procedural serviceModifier

59	Distinct procedural service
XE	Separate encounter
XU	Unusual non-overlapping service

Miscellaneous CPT/claim mapping referencesmixed

62320-62327

Range referenced in policy for epidural/subarachnoid injections

Procedural/pain bundled codes allowed with modifiers (example mappings)mixed

0214T	Example mapped in bundled-with-modifier table to other codes (see policy)
64405	Example mapping entry in bundled table (43755 -> 62320-62327 etc.)

Daily hospital management special handlingCPT

01996	Daily hospital management of epidural/subarachnoid drug administration — separately reimbursable once per date excluding insertion day in specified places of service; included if billed same date by Same Individual Physician
01967	Neuraxial labor analgesia — reimbursed based on Base Unit Value plus Time Units
01968	Obstetric add-on — time reported separately; may be reimbursed when reported by same or different individual than 01967

Anesthesia duplicate/simultaneous administration rulesModifier|CPT

QK	Modifier used when physician medically directs CRNA; permits 50% reimbursement for each when applicable
QX	CRNA service with medical direction
QY	Medical direction of one or more CRNAs

Claim reporting fields and electronic mappingmixed

24G	CMS 1500 item 24G (Days or Units) — report anesthesia minutes left justified, no leading zeros; enter 1 if one service
837P SV104	Electronic mapping: 24G maps to 2400/SV104 Service Unit Count

State exception examplesmixed

Florida	State-specific modifier percentages and limits (e.g., AD 50%, QK/QY 20%, QX/QZ 80%; limits on epidural minutes)
Idaho	State-specific AD 50% and modifier 59 use guidance
Wisconsin	Considers 01996 an anesthesia service and requires anesthesia modifiers; modifiers reimbursed per unit rates

Crosswalk guidancemixed

ASA CROSSWALK

Use ASA CROSSWALK for direct/alternate crosswalks between medical/surgical procedures and anesthesia codes

Brain function monitor guidancemixed

N/A	Use of a brain function monitor for intraoperative awareness is not separately reportable with an anesthetic service per ASA RVG

Certain codes receive special handling: CPT 01996 (daily hospital management) is paid once per date excluding the day of insertion and may be included when billed by the Same Individual Physician; CPT 01967 (neuraxial labor analgesia) is reimbursed using Base Units plus Time Units; obstetric add-ons 01968 and 01969 are reported and timed separately from 01967. CPT codes 01953 and 01996 are excluded from anesthesia time-based reporting per ASA RVG®. See the policy bundling and crosswalk tables for complete mappings of bundled procedural/pain management codes and HCPCS crosswalks.

Billing & documentation actions

Billing Rule

Submit anesthesia codes and modifiers

Submit anesthesia services using CPT anesthesia codes 00100-01999 (do not submit 01953 or 01996 as they are excluded from anesthesia time-based reporting). Report actual anesthesia time in one-minute increments. Always place a required anesthesia modifier in the first modifier position to identify personal performance, medical direction, or supervision status.

Affected codes: CPT 00100-01999 (exclude 01953 and 01996)
Required first-position anesthesia modifiers (e.g., AA, AD, QK, QX, QY, QZ) — modifier percentage affects reimbursement
Report anesthesia time as actual minutes (one-minute increments)

Billing Rule

Use of modifier 59/XE/XU to unbundle

When a procedural or pain management service represents a distinct, separate encounter from the anesthesia service, append modifier 59, XE, or XU to the procedural/pain-management CPT code to unbundle and indicate a separate service.

Claim reporting rules and examples

Reporting anesthesia time/units on claims

Follow these rules when reporting anesthesia time or units on claims:

ALL of the following

Minutes on paper claims: Anesthesia services must be reported as minutes on the CMS 1500 paper claim (02-12) and corresponding electronic transaction; units may only be reported for anesthesia services when the code description includes a time period (such as 'daily management').Anesthesia services must be reported as minutes
Paper field formatting: On paper claims using CMS Paper Format 02-12, item 24G (Days or Units) should contain the number of days or units (enter numeral 1 if only one service is performed).
Enter numbers left justified; no leading zeros; use decimal point for fraction of a unit.

Special situations and clinical guidance

Daily Hospital Management and Specific Codes

Special handling for certain anesthesia related HCPCS/CPT codes:

ALL of the following

01996 daily management: CPT 01996 (daily hospital management of epidural/subarachnoid drug administration) is separately reimbursable once per date of service excluding day of insertion when in CMS place of service 19/21/22/25; 01996 is included in pain management procedure if submitted same date by Same Individual PhysicianOnce per date excluding insertion day
01967 neuraxial labor analgesia: CPT 01967 (neuraxial labor analgesia) reimbursed based on Base Unit Value plus Time Units
Obstetric add-on codes: Obstetric add-on CPT codes 01968 and 01969 may be reimbursed when reported by same or different individual than 01967 for same patient; time for 01968/01969 reported separately and not added to 01967 time

Key definitions

Definitions (brief)

Allowable AmountDollar amount eligible for reimbursement to the physician or other qualified health care professional on the claim (contracted rate, reasonable charge, or billed charges as applicable).

Anesthesia TimeBegins when the Anesthesia Professional prepares the patient for induction in the operating room or equivalent area and ends when the Anesthesia Professional is no longer in personal attendance and patient may be safely placed under postoperative supervision; involves continuous actual presence.

Anesthesia ProfessionalAn Anesthesiologist, CRNA, Anesthesia Assistant (AA), or other qualified individual working independently or under medical supervision.

Base Unit ValueNumber of units representing the Base Value per code of all usual anesthesia services, excluding time and modifying units.

Definitive SourceSources containing exact codes, modifiers or very specific instruction from a given source.

Frequently asked questions

Medicare determinations & external guidance

Medicare determination: the Federal Register guidance "Improvements for Medicare Anesthesia Teaching Programs" (Federal Register, November 25, 2009) is referenced for anesthesia teaching program reporting guidance and is included in the policy resources and determinations; the policy cites this document and its effective date of November 25, 2009.

Document revision timeline

2/20/2026revisedLatest

Anesthesia Services Bundled into HCPCS Procedural Codes section updated.

2/1/2026revised

Annual review version update and history archived entries prior to 2/1/2024.

11/16/2025revised

State Exceptions: Idaho added.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyAnesthesia Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Planopen_in_new

Policy CodePolicy N/A

Change TypeRevisions and state exceptions updates (multiple)

Effective Date

Next Review Date

SourceLink

On This Page

Qualifying Circumstances

Qualifying circumstance codes may be reported when applicable, however no additional base units are allowed for these circumstances.

ALL of the following

Qualifying circumstance CPT codes that identify conditions significantly affecting the anesthetic service include 99100, 99116, 99135, and 99140.
Consistent with CMS guidelines and UnitedHealthcare Community Plan policy, no additional base units are permitted for qualifying circumstance codes; these codes do not increase the base unit component of time-based reimbursement.
If reporting qualifying circumstance codes, ensure accurate documentation supports the reported circumstance; these codes may affect clinical reporting but do not change base unit calculations.

Bundling and Crosswalk Rules

Apply ALL of the following bundling and crosswalk rules when evaluating whether procedural/pain management services are separately reimbursable with anesthesia services:

ALL of the following

UnitedHealthcare Community Plan references CMS NCCI edits, ASA RVG®, and the ASA CROSSWALK® when determining bundling; where CMS NCCI edits exist, those edits are managed under the UnitedHealthcare Community Plan 'CCI Editing Policy'.
Procedural/pain management services or anesthesia services identified as bundled (integral) are not separately reimbursable when performed by the Same Individual Physician or Other Qualified Health Care Professional (same Federal Tax Identification number) on the same date of service.
Services listed in the CMS National Physician Fee Schedule with status indicator B (Bundled) or T (Injections) are considered bundled and not separately reimbursable with anesthesia administrations.
Services not separately reimbursed with anesthesia as stated in the CMS NCCI Policy Manual, Chapter 2 (even if not specifically listed) include codes such as 64561, 82800, 82803, 82805, 82810, 85345, 85347, and 85348; these are treated as bundled when performed by the same individual as the anesthesia service.
Nerve block codes billed in conjunction with anesthesia services follow bundling rules; when bundled, they are not separately reimbursable. When nerve block services are separately reportable per authoritative crosswalks (for example, ASA CROSSWALK or definitive guidance), appropriate modifiers and documentation must be used to support separate payment.
NPF (Non-Payment Flag) status indicators, where applied by referenced sources (CMS, ASA), will be honored; codes with NPF status are not separately reimbursable consistent with the source guidance.
Use of ASA CROSSWALK® or other authorized crosswalk methodologies is permitted to determine appropriate anesthesia code reporting when the source is definitive; interpretive crosswalks are applied per UnitedHealthcare Community Plan discretion and supported by documentation and coding guidance.
When reporting nerve block procedures that may require modifiers to indicate distinct procedural service (per CMS or ASA guidance), ensure modifier usage and documentation clearly justify separate reimbursement; failure to apply required modifiers or to provide supporting documentation may result in denial or bundling under this policy.

Documentation and supporting materials

Documentation and supporting materials must be available upon request to substantiate time, modifiers, medical direction, and any crosswalk or bundling determinations.

ALL of the following

Operative/anesthesia records must document actual anesthesia start and stop times in minutes and clearly support reported anesthesia time units; include entries for induction, emergence, and any intraoperative blocks with timing and the clinician performing each component.
Documentation must support the anesthesia modifier reported (AA, AD, QK, QX, QY, QZ, etc.), including medical direction elements when applicable (number of concurrent cases, presence and role of medical direction, supervision of CRNAs, and documentation of physician involvement during induction/extubation if AD is billed).
When multiple procedures or simultaneous services occur, documentation must clearly identify the procedures performed, times for each, and the relationship between procedures and anesthesia administration to justify use of a single highest base unit code and combined time reporting or to support separate additional administrations with appropriate modifiers (59, 76, 77, 78, 79, XE).
For qualifying circumstance codes and any reported modifying codes, clinical notes must describe the specific circumstance and clinical rationale; although no additional base units are allowed for qualifying circumstances, documentation is required to validate the reporting of these codes.
When asserting that a procedural or pain management service is separately payable from anesthesia (e.g., under an ASA CROSSWALK® or other definitive guidance), submit supporting source documentation, coding crosswalk reference, and clinical records demonstrating that the service was distinct and met criteria for separate payment; lack of adequate documentation may result in denial or bundling.
Providers should retain and produce on request any pertinent documentation used to determine code selection, crosswalk application, and modifier usage (including hospital records, anesthesia records, progress notes, and itemized operative reports).
Failure to provide adequate documentation upon request may result in denial, recoupment, or adjustment of payment in accordance with UnitedHealthcare Community Plan review processes and applicable state or contractual requirements.

ALL of the following

AA = Reimbursement Percentage = 100%
AD = Reimbursement Percentage = 100% (state exceptions may alter percentage)
QK = Reimbursement Percentage = 50%
QX = Reimbursement Percentage = 50%
QY = Reimbursement Percentage = 50%
QZ = Reimbursement Percentage = 100%
Altered circumstance modifiers: If reporting altered circumstance modifiers CPT 23 or 47 or HCPCS GC, G8, G9 or QS then no additional reimbursement is allowed above the usual fee for that service

Billing Rule

Duplicate code reimbursement and simultaneous MD/CRNA administration

When identical anesthesia codes are submitted more than once for the same patient on the same date of service, only the first submission is reimbursed. Exception: documented simultaneous administration by an MD and a CRNA may be reported separately with appropriate modifiers and will be reimbursed at 50% of the Allowed Amount to each provider.

Duplicate same-code submissions on same date: only the first is reimbursed
Simultaneous MD and CRNA administration: report appropriate modifiers (e.g., QK/QY and QX) and reimburse 50% to each

Billing Rule

Complete CMS-1500 item 24G for paper claims

For paper CMS-1500 claims, complete Item 24G (Anesthesia) as required by CMS formatting: enter anesthesia time in minutes, indicate units as total minutes, and follow spacing and punctuation rules so the entry maps correctly to electronic service unit fields.

Complete CMS-1500 Item 24G with total anesthesia minutes (one-minute increments)
Follow CMS formatting rules for Item 24G so paper entry is clear and mappable

Billing Rule

Map paper 24G to 837P Service Unit Count

When submitting electronically, ensure the paper Item 24G anesthesia minutes map to the 837P Service Unit Count (SV104). The service unit element (SV104) must reflect the total anesthesia minutes submitted on the paper form so electronic adjudication uses the same time-based units.

Map CMS-1500 Item 24G total minutes to 837P SV104 Service Unit Count
Ensure SV104 reflects total anesthesia minutes (one-minute increments)

Documentation Required

Anesthesia AD modifier documentation

Document physician presence during induction when reporting modifier AD to support the additional unit. Maintain anesthesia records that clearly indicate the physician's presence and participation during induction to justify AD payment.

Document physician presence during induction to justify AD additional unit
Retain anesthesia records demonstrating physician involvement during induction

Documentation Required

Submit supporting documentation when requested

When requested, submit supporting documentation (including the paper CMS-1500 form and accompanying anesthesia record notes) to validate time, modifier use, and any distinct procedural services. Provide the requested documentation promptly to avoid denials or payment delays.

Submit requested supporting documentation on paper (CMS-1500) with anesthesia record notes
Include time logs, modifier justification, and documentation of separate encounters as applicable

Billing Rule

Append modifier when reporting postoperative epidural/subarachnoid injections

When postoperative epidural or subarachnoid injections (CPT 62320-62327) are reported separately from anesthesia services, append modifier 59, XE, or XU to indicate a distinct procedural service and support separate reimbursement when appropriate.

Affected CPT codes: 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327
Append modifier 59/XE/XU when these codes are reported separately from anesthesia

Anesthesia teaching services reporting

Guidance for anesthesia teaching programs and reimbursement:

ALL of the following

Modifier-based reimbursement: Reimbursement for anesthesia teaching services is based on the specific modifier reported
Refer to Reimbursement Formula and Modifiers sections
Federal Register guidance: Refer to Federal Register (Nov 25, 2009) for reporting guidance on anesthesia teaching services