Florida Blue Anesthesia Coverage Update

Policy overview

Payer: Florida Blue; Policy Title: Anesthesia Services; Policy Number: 10-003; Effective Date: 2008-11-15. This policy defines Florida Blue payment and billing rules for anesthesia services (CPT range 00100-01999) and related anesthesia and sedation codes. It applies to billing on a CMS-1500 or equivalent claim form and treats “same provider” as practitioners reporting under the same Federal Tax Identification number. The policy covers reimbursement methodology using ASA base units and an anesthesia conversion factor, required anesthesia modifiers and their modifier adjustments, time reporting and conversion to 15-minute increments, rules for monitored anesthesia care (MAC) and moderate (conscious) sedation (including CPT codes 99151-99157 and G0500), treatment of epidurals and daily management (including codes 62324-62327 and 01996), and requirements for medical direction versus supervision including calculation and billing implications.

Coverage and clinical eligibility criteria

Covered when ALL of the following are met:

ALL of the following

The procedure for which the anesthesia is administered is a covered service.
Anesthesia administered by
- Physician (other than the operating physician, assistant surgeon, or obstetrician) qualified to administer general anesthesia or to appropriately supervise anesthesia.
- Certified Registered Nurse Anesthetist (CRNA).
- Anesthesiologist Assistant (AA).

ALL of the following

Requested by the attending physician/operating surgeon.
Performance of a pre-anesthetic examination and evaluation.
Prescription of the anesthesia care required.
Administration of necessary oral and parenteral medications.
Personal participation in, or medical direction of, the entire plan of care.
Continuous physical presence of the anesthesiologist or, if medically directing a qualified anesthetist (e.g., CRNA, AA), the anesthesiologist must be present in the operating suite or in proximate presence and available for diagnosis or treatment of emergencies.

ALL of the following

The physician performs a pre-anesthetic exam and evaluation and prescribes the anesthesia plan.
The physician participates in the most demanding anesthesia-related procedure(s) such as induction and emergence, or performs the key portions of the anesthetic as required by applicable guidance.
The physician remains physically present and immediately available during critical portions of the anesthetic and in the operating suite or proximate to it as required.
The physician provides continued medical direction and is available for diagnosis or treatment of emergencies.
Permitted short-duration activities while medically directing
- Discussing the case with the surgeon during brief intervals.

ALL of the following

If services are provided by a CRNA and the anesthesiologist does not meet medical direction criteria, the CRNA should submit with the QZ modifier (anesthesia performed by CRNA).
When medical supervision (not direction) is provided by an anesthesiologist and direction requirements are not met, the supervising anesthesiologist’s services are not separately reimbursed; supervision is considered part of the hospital ancillary services and is included in the facility payment.

ALL of the following

Anesthesia by hypnosis.
Anesthesia by acupuncture.
Anesthesia for cosmetic surgery (when procedure is cosmetic and not a covered service).
Standby, non-active participation for anesthesiology during surgery.
Anesthesia for investigational or non-covered surgical procedures.

ALL of the following

Usual pre-operative and post-operative visits and consultations included in the anesthesia reimbursement.
Anesthesia care during the procedure, including administration of fluids and/or blood, and usual monitoring services (e.g., ECG, temperature, blood pressure, oximetry, capnography, mass spectrometry).
Positioning of the patient before, during, or following a therapeutic procedure is incidental and not reimbursed separately.
Time spent in the recovery room is included in the anesthesia base units; no additional recovery-room reimbursement is provided.
Specific procedures and services considered integral and not separately reimbursed (not all-inclusive): 31500, 31505, 31515, 31527, 31622, 36000, 36430, 92950, 92953, 92960, 93000-93010, 93040-93042, 93922-93924, 94002, 94640, 94680-94690, 94760-94762, 95812-95822.

Billing & reimbursement rules (actionable)

Billing Rule

Report total anesthesia minutes

Report total anesthesia minutes in field 24G and follow Florida Blue conversion/rounding rules when submitting claims.

Provider action: Report total anesthesia minutes as minutes (not time units) in field 24G; Florida Blue converts minutes into 15-minute increments and rounds to the nearest tenth.

Billing Rule

Include appropriate anesthesia modifier

Include the appropriate anesthesia modifier on the time-based anesthesia line so Florida Blue can apply the correct payment calculation and modifier adjustment.

Provider action: Include one of the following modifiers on the anesthesia time line: AA, QZ, QK, QX, QY.
Affected codes: All time-based anesthesia CPT codes (00100-01999) and relevant moderate sedation/anesthesia add-on codes.

Code lists and coding guidance

Covered Anesthesia CPT RangeCPTCovered

00100-01999

Anesthesia procedures

Moderate Sedation CPT CodesCPTCovered

99151	Moderate sedation initial 15 minutes; patient <5, same physician
99152	Moderate sedation initial 15 minutes; patient >=5, same physician
99153	Moderate sedation each additional 15 minutes (technical component only)
99155	Moderate sedation initial 15 minutes; second physician in facility; patient <5
99156	Moderate sedation initial 15 minutes; second physician in facility; patient >=5
99157	Moderate sedation each additional 15 minutes by second physician
G0500	Initial 15 minutes for GI endoscopic procedure sedation provided by same physician

Qualifying Circumstance Codes (Included in Base Allowance)CPTCovered

99100-99140	Qualifying circumstances for anesthesia (included in basic allowance)
99116	Anesthesia complicated by utilization of total body hypothermia (List separately)
99135	Anesthesia complicated by controlled hypotension (List separately)
99140	Anesthesia complicated by emergency conditions (List separately)

Epidural and Management CodesCPTCovered

62324-62327	Continuous epidural codes; reimbursed one time as flat rate
01996	Daily hospital management of epidural or subarachnoid continuous drug administration; one service per day; reimbursed at 3x conversion factor

Labor Epidural CodesCPTCovered

01967	Vaginal delivery with epidural for pain management; time-based; max 420 minutes
01968	Cesarean delivery following failed attempt at vaginal delivery; add-on; must be reported with 01967
01969	Cesarean delivery followed by cesarean hysterectomy after failed planned vaginal delivery; add-on; must be reported with 01967

Inclusive Component Codes (Not Separately Reimbursed with Anesthesia)CPTNot Covered

31500	Intubation/endotracheal (integral to anesthesia)
31505	Laryngoscopy, indirect (listed as inclusive components)
31515	Laryngoscopy direct (inclusive)
31527	Laryngoscopy direct with obturator (inclusive)
31622	Bronchoscopy (inclusive when performed with anesthesia)
36000	Introduction of needle or intracatheter, vein (inclusive)
36430	Transfusion, blood or blood components (inclusive)
92950	Cardiopulmonary resuscitation (inclusive)
92953	Temporary transcutaneous pacing (inclusive)
92960	Cardioversion, elective (inclusive)

1–10 of 18

1/2

HCPCS Modifiers for AnesthesiaModifier

AA	Anesthesia services performed personally by anesthesiologist (Modifier Adjustment = 100%)
AD	Medical supervision by a physician, more than 4 concurrent anesthesia services
G8	Monitored anesthesia care for deep complex, complicated, or markedly invasive surgical procedure
G9	Monitored anesthesia care for patient with history of severe cardiopulmonary condition
QK	Medical direction of two, three, or four concurrent anesthesia procedures (Modifier Adjustment = 50%)
QS	Monitored anesthesia care service
QX	CRNA service; with medical direction by a physician (Modifier Adjustment = 50%)
QY	Medical direction of one CRNA by an anesthesiologist (Modifier Adjustment = 50%)
QZ	CRNA service; without medical direction by a physician (Modifier Adjustment = 100%)

CPT Physical Status Modifiers (Note: No additional reimbursement)Modifier

P1	Normal healthy patient
P2	Patient with mild systemic disease
P3	Patient with severe systemic disease
P4	Patient with several systemic diseases that is a constant threat to life
P5	Moribund patient who is not expected to survive without the operation
P6	Declared brain-dead patient whose organs are being removed for donor purposes
47	Anesthesia by surgeon

Key definitions

Definitions

Anesthesia timeBegins when anesthesiologist first in attendance for induction and ends when anesthesia practitioner is no longer furnishing anesthesia services; includes recovery room time.

Monitored Anesthesia Care (MAC)Intraoperative monitoring in anticipation of need for general anesthesia or adverse physiologic reaction; identified by modifier QS; coverage requires specified criteria and is limited to one provider per day.

Moderate (conscious) sedationDrug-induced depression of consciousness where patients respond purposefully to verbal commands; intraservice time must be documented and used to select appropriate code; preservice/postservice times are not used.

Medical directionSpecific set of requirements an anesthesiologist must meet to medically direct up to four concurrent anesthesia providers (physical presence in operating suite, pre-anesthetic exam, prescribe plan, participate in induction/emergence, monitor and provide post-anesthesia care).

Inclusive components (not separately reimbursed)

The policy states that certain procedures and services are integral to general anesthesia and are not reimbursed separately. Billing staff should bundle these items with the anesthesia service and not submit them as separate payable lines when reported on the same date of service with anesthesia.

References

Evidence/references: CMS NCCI Policy Manual, Chapter 2; CMS Medicare Claims Processing Manual, Publication 100-4, Chapter 12, Section 50; American Society of Anesthesiologists: Relative Value Guide. Operational notes: the policy explicitly applies to services billed on a CMS-1500 or equivalent claim form and defines “same provider” as practitioners reporting under the same Federal Tax Identification number. Florida Blue converts reported anesthesia minutes (submitted in field 24G) into 15-minute increments and rounds time units to the nearest tenth when computing allowances.

Policy changes & history

2008-11-15original_effective

Policy originally effective (Original Effective Date 11/15/2008).

2025-06-12annual_reviewLatest

06/12/2025 annual review and references updated.

2025-06-12clarificationLatest

Clarifying language added to indicate this policy applies to billing for services on a CMS-1500 or equivalent claim form.