Report anesthesia time and conversion

Report the actual anesthesia time spent administering anesthesia as minutes in the claim 'days or units' block; the Plan will convert total minutes to time units. Time units = total minutes ÷ 15, rounded to one decimal place. For moderate (conscious) sedation, report units (not minutes).

• Conversion example: 48 minutes = 48 ÷ 15 = 3.2 time units

Do not bill monitoring separately with anesthesia / Use modifier 59 when independent

Monitoring and other supportive services performed as part of anesthesia care are bundled into the anesthesia allowance and are not separately reimbursed when reported on the same date of service. If a monitoring/supportive service is independently performed and clearly distinct from the anesthesia service, it may be reported separately only with modifier 59 and documentation that supports its independent performance.

• Common monitoring examples: ECG/EKG monitoring, pulse oximetry (oxygen saturation), end-tidal CO2 monitoring (capnography), blood pressure, temperature, respiratory monitoring.
• If itemized charges for monitoring/support are submitted the Plan will combine them with the anesthesia charge and reimburse only the anesthesia.
• When modifier 59 is used, the patient medical record must support its use per CPT guidance.
• Participating/network providers may not separately bill the member for bundled monitoring services.

Documentation for directed anesthesia

Directed anesthesia must be supported by the anesthesia record and clinical documentation showing the physician's pre-anesthetic exam, prescribed anesthesia plan, participation in induction/emergence or the most demanding portions of care, monitoring, and post-anesthesia care. When physician and CRNA both bill full fees for the same case, documentation from both providers must support payment splits or full fees.

• Required documentation: pre-anesthetic examination and evaluation, anesthesia plan, record of personal participation in induction and/or emergence when billed, monitoring notes, and post-anesthesia care.
• Identify physicians in group practices explicitly in the record to support who performed or directed services.
• When payment is requested for both physician and CRNA full fees, submit documentation from both providers that supports medical necessity for dual payment and the distinct services performed.

Obstetrical add-on codes: billing and rejection risk

Obstetrical anesthesia add-on codes must never be billed as standalone services and must be reported on the same date of delivery as the primary anesthesia code. Mismatched dates, missing the required primary code, or billing these add-ons alone will result in claim rejection or denial.

• Obstetrical add-on codes: 01967, 01968, 01969
• These codes must accompany the primary anesthesia code and share the delivery date; omission of the primary code or a different date may cause rejection.

Elastomeric pump and catheter billing

Catheter insertion and removal for continuous local analgesia delivered via elastomeric pumps are included in the surgical allowance and are not separately reimbursable. Elastomeric pump supplies (A4305, A4306) are most commonly reported by facilities; physician reporting is subject to customer or group benefits.

• Catheter insertion/removal included in surgical allowance; do not bill separately.
• Elastomeric pump supply codes: A4305, A4306 — usually facility supplies; physician coverage depends on individual/group customer benefits.

Do not separately reimburse listed modifying unit codes

The Plan will not separately reimburse the listed modifying unit codes. Exceptions for Medicare Advantage or New York regional rules may apply as noted in policy.

• Do not separately reimburse: 99100, 99116, 99135, 99140
• Medicare Advantage / New York: follow regional/MA-specific guidance where applicable.

Dental anesthesia billing units

For dental anesthesia, bill the initial 15-minute unit on one line and subsequent 15-minute increments on separate lines using the appropriate CDT codes and units.

• Initial 15 minutes: D9222 or D9239
• Subsequent 15-minute increments: D9223 or D9243

Aborted or cancelled surgery billing

When surgery is aborted or cancelled, follow these billing rules: if surgery is cancelled because of the anesthesiologist's preoperative appraisal, reimbursement may be considered as a consultation per member benefits. If surgery is aborted after induction, reimbursement is based on 3 basic units plus time units multiplied by the conversion factor. Documentation of events and anesthesia records is required.

• Cancelled due to anesthesiologist pre-op appraisal: may bill as consultation (coverage determined by member benefits).
• Aborted after induction: reimbursement = 3 base units + time units × conversion factor; submit anesthesia record.
• If anesthesia is reported under an NOC/NOS code for postponement, the Plan will adjudicate per policy guidelines.
• Detailed documentation and medical records must accompany appeals or requests for consideration.

Report appropriate anesthesia modifiers

Append the appropriate anesthesia modifiers to claim lines to denote who performed, directed, or supervised the service and to indicate patient physical status. QS is informational only and time must still be reported; other modifiers affect payment methodology.

• Key anesthesia modifiers: AA (anesthesiologist performed personally), AD (medical supervision >4 concurrent procedures), QK (medical direction of 2–4 concurrent CRNAs), QX (CRNA service with physician direction), QY (medical direction of one CRNA), QZ (CRNA service without direction), G8 (MAC for deep complex procedures), G9 (MAC for severe cardio-pulmonary condition), QS (monitored anesthesia care — informational).
• Physical status modifiers: P1, P2, P3, P4, P5, P6 — report as applicable.
• QS modifier is informational only; actual anesthesia time must still be reported on the claim line.
• When reporting directed/delivery scenarios, ensure modifier use is accompanied by supporting documentation per policy.