CurrentColorado Rocky Mountain Health PlansPolicy 2026R9008A

Anesthesia Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new

Defines UnitedHealthcare Medicare Advantage reimbursement rules for anesthesia services billed on the CMS 1500 (CPT anesthesia codes 00100-01999, excluding specified codes), including modifiers, time reporting, formulas, bundling, duplicate services, and related billing rules.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyAnesthesia Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new

Policy CodePolicy 2026R9008A

Change TypePolicy Version Change (historical updates, no clinical changes)

Effective Date

Next Review Date

Key ActionReport actual Anesthesia Time in one-minute increments and retain documentation supporting start and end times.

SourceLink

POLICY UPDATE CHANGES

Policy Version Change dated 2/1/2026

Policy Version Change dated 2/1/2025

Policy Version Change dated 2/1/2024

00100-01999Anesthesia CPT code range covered

01953, 01996CPT codes explicitly excluded

AA, AD, QK, QY, QZ, QXModifiers referenced

Policy Summary

Policy Number 2026R9008A; Payer: UnitedHealthcare Medicare Advantage; Status: CURRENT. This policy aligns reimbursement for anesthesia services with the ASA Relative Value Guide, ASA CROSSWALK, and CMS methodology and governs identification of anesthesia CPT codes, required anesthesia modifier usage, anesthesia time reporting, bundling and duplicate-service rules, and select exceptions such as daily hospital management (01996) and critical care. It applies to anesthesia CPT codes 00100-01999 while explicitly excluding 01953 and 01996 from time‑based anesthesia reporting, requires anesthesia modifiers in the first modifier position with modifier percentage adjustments to Allowed Amount, mandates actual Anesthesia Time reported in 1‑minute increments, addresses bundling when the same individual furnishes anesthesia and the procedure (including use of modifier 47), limits reimbursement for duplicate codes (only first submission reimbursed) and describes exceptions for simultaneous MD/CRNA administration and the separate reimbursement of critical care (CPT 99291-99292).

Policy Metadata

Policy Number2026R9008A

PayerColorado Rocky Mountain Health Plans / UnitedHealthcare Medicare Advantage

Policy TitleAnesthesia Services Policy

Effective Date

Last Review2026-02-01

Next Review

StatusCURRENT

Scope SummaryDefines UnitedHealthcare Medicare Advantage reimbursement rules for anesthesia services billed on the CMS 1500 (CPT anesthesia codes 00100-01999, excluding specified codes), including modifiers, time reporting, formulas, bundling, duplicate services, and related billing rules.

Reimbursement Criteria and Rules

Anesthesia Service Identification and Time Reporting

Anesthesia services must meet the following to be reimbursed as time-based anesthesia services:

ALL of the following

Anesthesia CPT code range: Service submitted with a CPT anesthesia code in the range 00100-01999 excluding 01953 and 01996
CPT codes 01953 and 01996 are excluded from being considered anesthesia services for time-based reporting per ASA RVG
Required anesthesia modifier: Submitted with a required anesthesia modifier in the first modifier position identifying personally performed, medically directed, or medically supervised service (e.g., AA, AD, QK, QY, QZ, QX)
Modifier Percentage will adjust Allowed Amount per modifier table
Anesthesia time reporting: Anesthesia Time reported in one-minute increments (actual minutes)1 minute increments
Time begins when preparing patient for induction and ends when no longer in personal attendance

Modifier Percentage Application

Allowed Amount is adjusted by modifier percentage as follows:

Modifier percentages

AA (Anesthesiologist personally performed) = 100% reimbursement percentage
Provider type = Anesthesiologist MD Personally Performed
AD (Anesthesiologist MD supervising >4) = 100% reimbursement percentage
Provider type = Anesthesiologist MD Supervising over 4
QK (Anesthesiologist MD supervising 2-4) = 50% reimbursement percentage
QY (CRNA or AA directed by Anesthesiologist MD supervising 1) = 50% reimbursement percentage
QZ (CRNA personally performed) = 100% reimbursement percentage

Reimbursement Formulas

Time-based anesthesia services reimbursed according to Standard Anesthesia Formula:

Reimbursement formulas

Standard Formula without AD: Standard Anesthesia Formula without Modifier AD = ([Base Unit Value + Time Units + Modifying Units] x Conversion Factor) x Modifier Percentage
Standard Formula 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
Include anesthesia notes to support physician presence for AD additional unit

Qualifying Circumstances

Qualifying circumstance codes do not allow additional base units:

Qualifying circumstances: Qualifying circumstance codes: 99100, 99116, 99135, 99140 — no additional base units allowed

Multiple or Duplicate Anesthesia Services

Rules when multiple procedures or duplicate codes are reported:

Single anesthesia code for multiple procedures: When multiple surgical procedures during single anesthesia, report only single anesthesia code with highest Base Unit Value; time reported is combined total for all procedures on same date by same or different providers
Add-on codes handling: 01953 is an add-on used with 01952; 01968/01969 are add-ons used with 01967; only base unit of add-on code allowed; anesthesia time reported with primary anesthesia code
Anesthesia add-on codes are priced differently
Duplicate submissions: Duplicate same anesthesia codes reported for same patient/date by same or different providers — reimburse only the first submission of that code
Exceptions / Additional Reimbursement

Anesthesia and Procedural Bundled Services

Bundling rules when same individual furnishes anesthesia and procedure:

Same Individual bundling: Do not separately reimburse anesthesia service when reported with a medical or surgical procedure submitted by the Same Individual Physician or Other Qualified Health Care Professional for same patient and date of service (anesthesia included in procedure payment)
CMS NCCI Policy Manual indicates many services are integral to anesthesia and not separately reimbursable
Modifier 47 usage: If physician personally performs regional/general anesthesia for a surgical procedure they also perform, append modifier 47 to surgical code and do not use anesthesia section CPT codes
Reference for integral services: CMS NCCI Policy Manual, CMS NCCI edits and National Physician Fee Schedule are used to determine when services are integral and not separately reimbursable

Code Lists

Anesthesia CPT codes included as anesthesia servicesCPTCovered

00100-01999

CPT anesthesia codes reimbursed as time-based using Standard Anesthesia Formula (excluding listed exclusions).

CPT codes excluded from anesthesia servicesCPTNot Covered

01953	Add-on anesthesia code used only with 01952; per policy not considered a standalone anesthesia service and is priced as an add-on (only base unit allowed).
01996	Used for other services not considered time-based anesthesia per ASA RVG®; excluded from anesthesia services reimbursement as time-based.

Anesthesia add-on codes (priced differently)CPT

01952 / 01953	01952 is a primary anesthesia code; 01953 is an add-on reported with 01952. Add-on codes are priced differently — only the base unit of the add-on code is allowed. Anesthesia Time should be reported with the primary anesthesia code.
01967 / 01968 / 01969	01967 is a primary anesthesia code; 01968 and 01969 are add-ons reported with 01967. Add-on codes are priced differently — only the base unit of the add-on code is allowed. Anesthesia Time should be reported with the primary anesthesia code.

Qualifying circumstance codes (no additional base units)CPT

99100	Qualifying circumstance — extreme age (under 1 year). No additional base units allowed.
99116	Qualifying circumstance — regional block face/neck done pre-/post-anesthesia (per ASA/CMS guidance). No additional base units allowed.
99135	Qualifying circumstance — emergency conditions or other qualifying circumstance as defined; no additional base units allowed.
99140	Qualifying circumstance — traumatic event or other significant alteration of anesthetic management; no additional base units allowed.

Anesthesia modifiers and reimbursement impactModifier

AA	Anesthesiologist MD personally performed — Reimbursement Percentage = 100% (modifier must be in first modifier position).
AD	Anesthesiologist MD supervising over 4 CRNAs/AAs — Reimbursement Percentage = 100% (special AD formula applies).
QK	Anesthesiologist MD medically directing 2-4 concurrent anesthesia procedures — Reimbursement Percentage = 50%.
QY	Anesthesiologist MD medically directing 1 concurrent CRNA/AA — Reimbursement Percentage = 50%.
QZ	CRNA personally performed — Reimbursement Percentage = 100% when applicable (policy notes QZ = 50% = 100% text per source).
QX	CRNA/AANA or other modifier indicating CRNA medically directed? (Used with split billing scenarios as applicable per policy).
47	Anesthesia modifier 47 (anesthesia by surgeon) — when reported, no additional reimbursement allowed above the usual fee for that service per policy.
59	Modifier 59 (distinct procedural service) — may be used to indicate a separate operative session; when used to indicate a separate anesthesia session on the same day, UnitedHealthcare will reimburse one additional anesthesia administration appended with 59 (see Multiple/Duplicate Anesthesia Services).
76	Modifier 76 (repeat procedure by same physician) — allowed to indicate a separate anesthesia session on same day when appropriate; may permit reimbursement for an additional anesthesia administration per policy.
77	Modifier 77 (repeat procedure by another physician) — allowed to indicate a separate anesthesia session on same day when appropriate; may permit reimbursement for an additional anesthesia administration per policy.

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Evaluation & Management and critical careCPT

99291	Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes — reimbursed separately from anesthesia services when applicable.
99292	Each additional 30 minutes of critical care beyond the first 74 minutes — reimbursed separately from anesthesia services when applicable.

Operational Billing & Documentation Requirements

Documentation Required

Accurate Anesthesia Time Documentation

Report actual Anesthesia Time in one-minute increments and retain documentation supporting start and end times (Anesthesia Time begins when preparing the patient for induction and ends when no longer in personal attendance).

Anesthesia Time reporting increment: 1 minute increments

Billing Rule

Use required anesthesia modifier in first modifier position

Submit all anesthesia services with the appropriate anesthesia modifier in the first modifier position. The modifier must identify personal performance, medical direction, or supervision; the Allowed Amount will be adjusted by the modifier percentage.

Applicable modifiers: AA, AD, QK, QY, QZ, QX
Modifier percentage will adjust Allowed Amount

Billing Rule

Report only highest base unit anesthesia code for multiple procedures

When multiple procedures are performed during a single anesthesia administration, report only the single anesthesia code with the highest Base Unit Value and report the combined anesthesia time for all procedures.

Billing Rule

Duplicate code reimbursement limitation

When the same anesthesia code is reported multiple times for the same patient and date, only the first submission will be reimbursed. If anesthesia administration services are rendered simultaneously by an MD and a CRNA during the same operative session, each may be reimbursed at adjusted percentages by reporting the appropriate modifiers.

Simultaneous MD and CRNA reimbursement: report QK or QY and QX to split payment (each receives percent per modifier table)

Billing Rule

01996 reporting and place of service limitation

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

01996

Billing Rule

Bundling when same individual performs procedure and anesthesia

Do not separately bill anesthesia CPT codes when the same individual performs both the surgical/procedural service and the anesthesia. Instead, append modifier 47 to the surgical code and do not use anesthesia section CPT codes.

Append modifier 47 to the surgical code when physician performs both procedure and anesthesia

Documentation Required

Modifier-specific operational notes

When using modifier AD, include anesthesia notes documenting the physician's presence during induction to claim the additional unit under the AD reimbursement formula.

Billing Rule

Screening colonoscopy PT modifier cost share

When anesthesia claim lines are furnished in conjunction with screening colonoscopy services billed with modifier PT, coinsurance and deductible do not apply to those anesthesia lines.

Key Terms

Definitions

Allowable AmountDollar amount eligible for reimbursement to the physician or other qualified health care professional on the claim.

Anesthesia ProfessionalAn Anesthesiologist, Certified Registered Nurse Anesthetist (CRNA), Anesthesia Assistant (AA), or other qualified individual working independently or under physician supervision.

Anesthesia TimeBegins when the Anesthesia Professional prepares the patient for induction and ends when no longer in personal attendance; reported in one-minute increments.

Base Value / Base Unit ValueUnits assigned by ASA representing base value per anesthesia code, includes usual pre/postoperative visits and monitoring interpretation but excludes certain invasive procedures.

Conversion FactorIncremental multiplier rate defined by contracts or industry standards used in reimbursement calculation.

Modifier PercentageReimbursement percentage allowed for anesthesia services based on modifier indicating personal performance, medical direction, or supervision (e.g., AA or AD = 100%; QK or QY = 50%; QZ = 100% as applied).

Same Individual Physician or Other Qualified Health Care ProfessionalThe same individual rendering health care services reporting the same National Provider Identifier (NPI) number.

Same Specialty Physician or Other Qualified Health Care ProfessionalPhysicians and/or other qualified health care professionals of the same group and same specialty reporting the same Federal Tax Identification number.

OpenPayer

Anesthesia Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new

Policy Summary

Reimbursement Criteria and Rules

Code Lists

Operational Billing & Documentation Requirements

Key Terms

Common Billing Questions

Medicare References & External Guidance

Policy Changes