ModifiedColorado Rocky Mountain Health Plans | UnitedHealthcarePolicy 2026R0032A

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

Defines UnitedHealthcare Commercial and Individual Exchange reimbursement rules for anesthesia services billed on CMS-1500 (and when specified UB04), including code ranges, modifiers, time reporting, formulas, bundling rules, duplicate/multiple service handling, obstetric/neuralaxial specifics, qualifying circumstances, and documentation/billing instructions.

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 TypeMODIFIED

Effective Date

Next Review Date

Key ActionSubmit anesthesia services with CPT codes 00100-01999 (excluding 01953 and 01996) and append a required anesthesia modifier in the first modifier position; UnitedHealthcare will adjust Allowed Amount by modifier percentage.

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

01953,01996Excluded from time-based anesthesia

435

01967 neuraxial minutes cap

4Max CRNAs supervised for QK

Policy summary

UnitedHealthcare aligns its anesthesia reimbursement methodology with the American Society of Anesthesiologists (ASA) Relative Value Guide (RVG®), the ASA CROSSWALK®, and CMS sources including the NCCI Policy Manual and the CMS Physician Fee Schedule to define payment rules for anesthesia services billed on the CMS-1500 (and UB04 when specified).

This policy applies to UnitedHealthcare Commercial and Individual Exchange products and governs anesthesia CPT codes in the range 00100-01999 (with explicit exclusions 01953 and 01996), anesthesia modifier requirements and modifier impact on the Allowed Amount, time reporting, the standard anesthesia reimbursement formulas, bundling rules with procedural/pain management and HCPCS crosswalk guidance, duplicate/multiple service handling, and specific obstetric and daily management rules (including neuraxial labor analgesia and add-on C-section codes).

Claims-form focus and high-level topics: submission on the CMS-1500 (or electronic 837P equivalent) with anesthesia modifiers in the first modifier position; use of ASA/CMS crosswalks for anesthesia-procedural bundling (including HCPCS procedural codes listed as bundled); time-based reporting in minutes; formula-driven reimbursement using Base Units, Time Units, a Conversion Factor and Modifier Percentage; rules on modifier percentages (AA, AD, QK, QX, QY, QZ); duplicate anesthesia reporting constraints; and obstetric-specific caps and add-on reporting rules (e.g., 01967 cap 435 minutes).

Policy identifiers and thresholds

policy_number2026R0032A

subjectAnesthesia professional reimbursement (CMS 1500)

statusMODIFIED

last_review2026-02-15

effective

next_review

Neuraxial labor analgesia time cap435 minutes cap for CPT 01967

Modifier 22 thresholdConsidered only for anesthesia services with Base Unit Value < 5; if approved additional base units added so total base units = 5

Anesthesia services submission and reimbursement criteria

Code lists and coding guidance

Anesthesia codes considered anesthesia services (time-based)CPTCovered

00100-01999

CPT anesthesia codes reimbursed as time-based; excludes 01953 and 01996

Excluded from anesthesia services (not time-based per ASA RVG)CPTNot Covered

01953	Not considered anesthesia services for time-based reporting
01996	Daily hospital management — treated separately (see rules); excluded from general anesthesia code range

Qualifying circumstances codes (no additional units allowed)CPTCovered

99100	Extensive surgical procedure
99116	Anesthesia complicated by emergency conditions
99135	Anesthesia complicated by emergency conditions
99140	Anesthesia complicated by emergency conditions

Procedural or Pain Management Codes Bundled into AnesthesiamixedNot Covered

0213T	Included on bundled list
0214T	Included on bundled list
0215T	Included on bundled list
0216T	Included on bundled list
0217T	Included on bundled list
0218T	Included on bundled list
36415	Included on bundled list
36416	Included on bundled list
36591	Included on bundled list
36592	Included on bundled list

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Procedural or Pain Management Bundled Codes Allowed with Modifiers (distinct procedural services when modifier 59, XE or XU appended)mixedCovered

62321	May be distinct procedural service when modifier 59, XE or XU appended
62322	May be distinct procedural service when modifier 59, XE or XU appended
62323	May be distinct procedural service when modifier 59, XE or XU appended
62324	May be distinct procedural service when modifier 59, XE or XU appended
62325	May be distinct procedural service when modifier 59, XE or XU appended
62326	May be distinct procedural service when modifier 59, XE or XU appended
62327	May be distinct procedural service when modifier 59, XE or XU appended
64400	May be distinct procedural service when modifier 59, XE or XU appended
64405	May be distinct procedural service when modifier 59, XE or XU appended
64408	May be distinct procedural service when modifier 59, XE or XU appended

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HCPCS crosswalk/HCPCS procedural codes bundled with anesthesia (examples)HCPCSNot Covered

G0105	Example HCPCS procedural code with anesthesia crosswalk
G0121	Example HCPCS procedural code with anesthesia crosswalk
G0186	Example HCPCS procedural code with anesthesia crosswalk
G0268	Example HCPCS procedural code with anesthesia crosswalk
G0339	Example HCPCS procedural code with anesthesia crosswalk
G0340	Example HCPCS procedural code with anesthesia crosswalk
G0341	Example HCPCS procedural code with anesthesia crosswalk
G0342	Example HCPCS procedural code with anesthesia crosswalk
G0343	Example HCPCS procedural code with anesthesia crosswalk
G0412	Example HCPCS procedural code with anesthesia crosswalk

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Modifiers referencedModifier

AA	Anesthesiologist personally performed
AD	Anesthesiologist supervising over 4 (medical direction)
QK	Physician medical direction of 2-4 CRNAs
QX	CRNA service billed with medical direction by anesthesiologist
QY	Anesthesiologist supervising 1 CRNA
QZ	CRNA personally performed
P1-P6	Physical status modifiers (informational only)
23, 47, GC, G8, G9, QS, 59, XE, XU	Other modifiers referenced with specific reimbursement/bundling rules

Special coding notes: Anesthesia modifiers identifying performance, medical direction or supervision must be appended in the first modifier position and UnitedHealthcare will adjust the Allowed Amount by the modifier percentage (for example AA=100%, QK/QY/QX=50%, QZ=85%).

Report actual Anesthesia Time in one-minute increments on claims (paper CMS-1500: minutes go in item 24G; electronic 837P: use SV104/Service Unit Count) and follow the policy rules for combining time across procedures or applying caps for neuraxial labor analgesia.

Duplicate anesthesia codes reported for the same patient on the same date will only reimburse the first submission; simultaneous MD/CRNA administration can be reported using the appropriate modifier pairs (for example QK/QX or QY/QX) so each provider receives the applicable percentage of the Allowed Amount.

When reporting CRNA services, use modifiers QX or QZ and report under the supervising physician's name or the employer/entity name under which the CRNA is contracted unless the CRNA is individually contracted/credentialed with UnitedHealthcare.

Refer to the provider_actions entries for detailed billing instructions on required modifier placement, time reporting fields, duplicate-code handling, and CRNA/physician pair reporting.

Billing, documentation, and submission requirements

Billing Rule

Use correct anesthesia codes and modifiers

Submit anesthesia services with CPT anesthesia codes in the range 00100–01999 (excluding 01953 and 01996). Append the required anesthesia modifier in the first modifier position. UnitedHealthcare will adjust the Allowed Amount by the modifier percentage per the modifier table.

Affected codes: 00100-01999 (excludes 01953 and 01996)
Modifier percentage adjusts Allowed Amount (see modifier table: AA=100%, QK/QX/QY=50%, QZ=85%, AD=100%)

Billing Rule

Time reporting

Report actual Anesthesia Time in one‑minute increments. For paper CMS‑1500 claims, enter anesthesia minutes in item 24G (Days or Units). For electronic 837P claims, report minutes in SV104/Service Unit Count (Service Unit Count maps to 24G).

Key term definitions

Definitions (key terms)

Anesthesia TimeBegins when Anesthesia Professional prepares patient for induction and ends when no longer in personal attendance; continuous presence.

Base ValueUnits representing base unit value per code; includes usual pre/post-op visits, administration of fluids/blood, interpretation of non-invasive monitoring; excludes placement of arterial/central lines and TEE.

Conversion FactorIncremental multiplier rate defined by specific contracts or industry standards; for non-network physicians based on a recognized national source.

Standard Anesthesia Formula([Base Unit Value + Time Units] x Conversion Factor) x Modifier Percentage (with AD-specific variant using base value of 3 and possible additional unit for presence during induction).

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

Same Specialty Physician or Other QHP

Frequently asked questions

FAQs (left)

Policy changes and revision timeline

2026-02-15material changeLatest

Policy version change dated 2/15/2026: Anesthesia Services Bundled into HCPCS Procedural Codes Section Revised; earlier entries prior to 2/15/2024 archived.

2025-10-01material change

Policy version change dated 10/01/2025: Modifiers, Reimbursement Formula, Obstetric Anesthesia Services, Definitions, and Question and Answers Section Revised.

2025-03-30change

Policy version change dated 3/30/2025: Updated Procedural or Pain Management Codes Bundled into Anesthesia and Procedural or Pain Management Bundled Codes Allowed with Modifiers; entries prior to 3/30/2023 archived.

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 TypeMODIFIED

Effective Date

Next Review Date

SourceLink

On This Page

Report time as minutes (one‑minute increments)

Paper CMS‑1500: item 24G = minutes

Electronic 837P: SV104 / Service Unit Count = minutes

Billing Rule

Duplicate code reimbursement

When the same anesthesia code is submitted multiple times for the same patient on the same date, only the first submission will be reimbursed. If an MD and CRNA concurrently administer anesthesia during the same operative session, report appropriate modifier pairs (e.g., QK or QY with QX) so each provider receives the applicable percentage of the Allowed Amount (per the modifier table).

Only the first submission of a duplicate anesthesia code for same patient/date is reimbursed
MD+CRNA simultaneous administration: report modifier pairs (QK/QX or QY/QX) and each receives percentage splits per modifier percentages

Billing Rule

Bundling and modifier 59/XE/XU usage

Procedural and pain management services that are bundled into anesthesia should not be billed separately by the Same Individual Physician or Other QHP on the same date of service unless the procedural code is appended with a modifier to indicate a distinct procedural service. Accepted modifiers to indicate distinct procedural services are 59, XE or XU.

Do not separately bill bundled procedural/pain management services when performed by the Same Individual Physician or Other QHP on same date
If distinct encounter, append modifier 59, XE or XU to the procedural/pain management code

Documentation Required

Modifier 22 supporting documentation

Requests for additional reimbursement using modifier 22 (unusual positioning/field avoidance) for anesthesia services with a Base Unit Value less than 5 must include supporting documentation submitted with a paper CMS‑1500 claim. Modifier 22 will be considered only when Base Units < 5 and, if approved, additional base units are added so total base units = 5.

Modifier 22 applies only when Base Unit Value < 5
Submit supporting documentation via paper claim (CMS‑1500)

Billing Rule

Daily hospital management (01996) billing constraint

CPT 01996 (daily hospital management of epidural/subarachnoid drug administration) is separately reimbursable one time per date of service (excluding the day of insertion) when billed in CMS places of service 19, 21, 22 or 25. If billed on the same date by the Same Individual Physician or Other QHP as the pain management procedure, 01996 is considered included in the pain management procedure and not separately reimbursable.

Allowed POS: 19, 21, 22, 25
Billable once per date of service (excluding insertion day)
01996 is included in the pain management procedure when submitted by Same Individual Physician or Other QHP on same date

Billing Rule

Obstetric add-on reporting

Neuraxial labor analgesia (CPT 01967) is reimbursed based on Base Units plus Time Units subject to a 435‑minute cap. Add‑on cesarean anesthesia codes 01968 and 01969 may be considered when billed with primary 01967; time for 01968/01969 is reported separately and is not added to 01967 time.

01967 time capped at 435 minutes
01968 and 01969 reported separately with their own time; do not add 01968/01969 time to 01967

Billing Rule

CRNA reporting

CRNA services should be reported with the appropriate CRNA modifier (QX when medically directed; QZ when personally performed). CRNA services must be reported under the supervising physician’s name or the employer/entity name under which the CRNA is contracted. In limited circumstances where the CRNA is individually credentialed/contracted with UnitedHealthcare, report under the CRNA’s name.

Use QX or QZ for CRNA reporting
Report under supervising physician or contracted entity name unless CRNA is individually credentialed/contracted with UnitedHealthcare

Physicians and/or Other QHPs of the same group and same specialty reporting the same Federal Tax Identification number.