CurrentHumanaPolicy CP2017001

Anesthesia Services (Revised)

Humana Medicare Advantage professional claims payment policy specifying coding, reporting, calculation and reimbursement rules for anesthesia services (CPT 00100-01999), modifier handling, time reporting, qualifying circumstances, physical status modifiers, and separate reimbursement for post-operative pain management procedures.

Policy Summary

PayerHumana

PolicyAnesthesia Services (Revised)

Policy CodePolicy CP2017001

Change TypeRevised (04/2026)

Effective Date

Next Review Date

Key ActionReport anesthesia services using CPT codes in the 00100-01999 range; when multiple procedures occur in one session report only the anesthesia code with the highest base unit and combined time with that code.

SourceLink

POLICY UPDATE CHANGES

Revision date updated to 04/2026; policy content on reimbursement and modifiers maintained.

1Anesthesia CPT range enforced

6Key anesthesia modifiers listed

4Qualifying circumstance codes listed

Policy summary

This Humana payment policy covers professional anesthesia services for Medicare Advantage products and provides high-level billing and reimbursement rules aligned with CMS MPFS and standard anesthesia coding practices. It applies to professional claims only and requires anesthesia services to be reported with CPT codes in the 00100-01999 range. The policy summarizes coding, time reporting, modifier handling, allowable calculation, qualifying circumstance rules, and criteria for separate reimbursement of post-operative pain management procedures.

Coverage and reimbursement criteria

Reporting Anesthesia Services

Humana requires anesthesia services to be reported using a CPT code in the specified anesthesia range.

Anesthesia services must be reported with a CPT code in the 00100-01999 range

Anesthesia Reimbursement Calculation

Humana's allowable calculation for time-based anesthesia services.

(CMS Base Value Unit + Time Units + Anesthesia Physical Status Modifier Unit, if applicable) x Conversion Factor = Anesthesia Allowable

Some anesthesia services are not time-based; this calculation does not apply to such services

Calculation does not apply to anesthesia services that are not time-based

Reporting Anesthesia Time

Requirements for reporting anesthesia time when applicable.

Report actual anesthesia time in one-minute increments in the anesthesia minutes fieldone-minute increments

Some anesthesia services are not time-based and are excluded from this requirement

Additional Reporting and Reimbursement Considerations

Rules for handling multiple procedures in a single anesthesia session and attending surgeon reporting.

When multiple procedures are performed during a single anesthesia session, report only the anesthesia service code with the highest base unit value and report the combined time for all procedures with that single code

Humana plans do not reimburse for anesthesia services reported by the attending surgeon

Claims reported by attending surgeon may be denied

Modifier handling, physical status & qualifying circumstances

Modifier-specific Reimbursement Rules

ALL of the following

For allowed anesthesia charges submitted with modifiers AA, QK, QX, QY or QZ, Humana plans reimburse a percentage of the provider's contracted rate or base maximum amount as follows: AA = 100%; QK = 50%; QX = 50%; QY = 50%; QZ = 100%.
An allowed anesthesia charge submitted with modifier AD is calculated using three base units regardless of the procedure code's base value units, multiplied by the conversion factor. One additional unit may be allowed when documentation confirms the supervising physician was present at induction. Additional units for length of time, qualifying circumstance codes, or physical status modifiers are not allowed with AD.
Monitored anesthesia care (MAC) must be indicated using modifier G8, G9 or QS, with the MAC modifier reported after AA, AD, QK, QX, QY or QZ.

Anesthesia Physical Status Modifiers (P1-P6)

ALL of the following

Humana Medicare Advantage plans do not allow additional base units for anesthesia physical status modifiers (P1–P6).
Humana commercial plans allow additional base units for certain physical status modifiers as follows: P3 = 1 additional unit; P4 = 2 additional units; P5 = 3 additional units. P1, P2 and P6 = No additional units.
Physical status modifiers should be reported after modifier AA, AD, QK, QX, QY or QZ. When multiple physical status modifiers are reported, follow standard coding guidance for reporting order; report the highest-severity applicable modifier.

Qualifying Circumstance Codes

ALL of the following

Humana Medicare Advantage plans do not allow additional base units for qualifying circumstance (add-on) codes (99100, 99116, 99135, 99140).
Humana commercial plans allow additional base units for qualifying circumstance codes as follows: 99100 = 1 additional unit; 99116 = 5 additional units; 99135 = 5 additional units; 99140 = 2 additional units.
Qualifying circumstance codes are add-on codes and must be billed in addition to the primary anesthesia service code.

Denial Risk

Anesthesia reported by attending surgeon — denial risk

Claims reported by the attending surgeon for anesthesia services may be denied.

Humana plans do not reimburse for anesthesia services reported by the attending surgeon.

Billing Rule

Append appropriate anesthesia modifiers

Append the appropriate anesthesia personnel modifier to the anesthesia service code. Use AA, AD, QK, QX, QY or QZ to indicate the anesthesia provider relationship; for monitored anesthesia care, append G8, G9 or QS after the personnel modifier.

Append one of: AA, AD, QK, QX, QY or QZ.
For monitored anesthesia care, append MAC modifier after personnel modifier: G8, G9 or QS.

Billing Rule

AD modifier special calculation

When billing with modifier AD (medical supervision of more than four concurrent anesthesia procedures), Humana calculates reimbursement using three base units regardless of the procedure's base unit value, multiplied by the conversion factor. Documentation that the supervising physician was present at induction may allow one additional unit. Additional units for time, qualifying circumstance codes, or physical status modifiers are not permitted with AD.

AD reimbursed as 3 base units × conversion factor.
One extra unit allowed only if documentation confirms physician presence at induction.
No additional units for time, qualifying circumstance codes, or physical status modifiers when AD is used.

Billing Rule

Report anesthesia time in minutes

Report actual anesthesia time in minutes using one-minute increments in the anesthesia minutes field. Do not include time for non-time-based anesthesia services or the time placing a separately reimbursed post-operative pain management procedure.

Report time in one-minute increments (not rounded to units).
Exclude non-time-based services and time for separately billed post-operative pain management procedures.

Billing Rule

Use CPT 00100-01999 for anesthesia services

Report anesthesia services using CPT codes in the 00100–01999 range. When multiple procedures occur during one anesthesia session, report only the anesthesia service code with the highest base unit value and report the combined anesthesia time with that code.

Use CPT codes 00100–01999 for anesthesia services.
When multiple procedures in one session, report only the highest base unit anesthesia code and combined time with that code.

Post‑operative pain management — separate reimbursement criteria

Post-Operative Pain Management Procedures - Separate Reimbursement Criteria

Criteria for separate reimbursement of post-operative pain management procedures.

Documentation separate: Medical record documentation of the post-operative pain management procedure must be separate from the anesthesia record and confirm the procedure was for post-operative pain management and that intra-operative anesthesia adequacy is not dependent on the epidural injection or nerve block

Procedure details: Documentation must include details about the procedure itself

Surgeon request: Documentation must confirm the surgeon requested the anesthetist administer the procedure

Patient consent: Documentation must confirm the patient consented to the post-operative pain management plan and procedure

Time exclusion: Time spent placing or administering the post-operative pain management procedure cannot be included in the intra-operative anesthesia time

Distinct procedural modifier: Modifier 59, XE or XU must be appended to the post-operative pain management procedure code to indicate a distinct procedural service

Timing: Post-operative pain management procedures may be administered pre-operatively, intra-operatively or post-operatively

Not separately reimbursed when: Post-operative pain management procedures are not separately reimbursed when reported by the same physician reporting the procedure or surgical charge

Documentation Required

Documentation required for separate reimbursement of post‑operative pain procedures

Post‑operative pain management procedures (eg, epidural, nerve block) billed separately must have documentation distinct from the anesthesia record confirming the procedure was for post‑operative pain management and that intra‑operative anesthesia adequacy is independent. The time to place/administer the procedure must be excluded from intra‑operative anesthesia time. Append modifier 59, XE or XU to indicate a distinct procedural service.

Documentation separate from the anesthesia record
Confirm procedure was for post‑operative pain management and intra‑operative anesthesia adequacy is independent
Include procedure details, surgeon request, and patient consent
Exclude placement time from intra‑operative anesthesia time
Append modifier 59, XE or XU

Code lists

Anesthesia CPT range required for reportingCPTCovered

00100-01999

Anesthesia services CPT range required for reporting

Physical status modifiersModifier

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

Anesthesia modifiersModifier

AA	Anesthesia services performed personally by anesthesiologist
AD	Medical supervision by physician: more than four concurrent anesthesia procedures
QK	Medical direction of 2-4 concurrent anesthesia procedures involving qualified individuals
QX	CRNA service: with medical direction by a physician
QY	Medical direction of one CRNA by an anesthesiologist
QZ	CRNA service: without medical direction by a physician
QS	Monitored anesthesia care service
G8	MAC for deep complex, complicated, or markedly invasive surgical procedures
G9	MAC for patient with history of severe cardio-pulmonary condition

Qualifying circumstance add-on codesCPT

99100	Anesthesia for patient of extreme age (<1 or >70) — add-on
99116	Anesthesia complicated by utilization of total body hypothermia — add-on
99135	Anesthesia complicated by utilization of controlled hypotension — add-on
99140	Anesthesia complicated by emergency conditions — add-on

Modifiers for distinct procedural service (post-op pain management)Modifier

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

OpenPayer

Anesthesia Services (Revised)

Policy summary

Coverage and reimbursement criteria

Modifier handling, physical status & qualifying circumstances

Post‑operative pain management — separate reimbursement criteria

Code lists

Key definitions

Policy changes