Qualifying Circumstances for Anesthesia
Customize your policy alerts
Sign up for Moda Health Policy RPM033 alerts
Get alerted when Policy RPM033 changes without checking for updates manually.
Monitor payer policy activity
Defines Moda Health's reimbursement stance for anesthesia add-on CPT codes 99100–99140, applicable to all providers and claim forms across Moda Partners, Inc. and subsidiaries.
No material clinical or coverage changes in this revision.
Anesthesia Add-on Code Coverage Criteria
Anesthesia add-on code coverage criteria
Covered when ALL of the following are met:
Qualifying Circumstance Add-on Codes & Reimbursement
| 99100 | Anesthesia for patient of extreme age, younger than 1 year and older than 70 (List separately in addition to code for primary anesthesia procedure). |
| 99116 | Anesthesia complicated by utilization of total body hypothermia (List separately in addition to code for primary anesthesia procedure). |
| 99135 | Anesthesia complicated by utilization of controlled hypotension (List separately in addition to code for primary anesthesia procedure). |
| 99140 | Anesthesia complicated by emergency conditions (specify) (List separately in addition to code for primary anesthesia procedure). |
| 99100-99140 | CPT codes 99100-99140 are not separately reimbursed; assigned status indicator 'B' (bundled) on the CMS Physician Fee Schedule. Claims for these codes deny to provider liability with Explanation Code indicating the service is bundled or incidental and RARC M15 noting the benefit is included in payment for another adjudicated service. |
Billing and Payment Actions
No separate reimbursement — 99100–99140 bundled (status B); denials expected
CPT codes 99100–99140 are not eligible for separate reimbursement; they are bundled (CMS status indicator 'B') and will deny to provider liability. Denials will indicate the service is bundled or incidental and reference RARC M15 noting the benefit is included in payment for another adjudicated service.
- Status indicator: B (bundled) per CMS Physician Fee Schedule.
- Denial messaging: Explanation Code indicating service is bundled or incidental and RARC M15 stating benefit is included in payment for another service.
Definitions and Claim Remark Codes
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.