ModifiedPremera BluecrossPolicy N/A

Anesthesia services reimbursement and billing guidelines

Governs how anesthesia units, modifiers, related services, and coding are applied for professional anesthesia claims across Premera Blue Cross lines of business and affiliated plans.

Policy Summary

PayerPremera Bluecross

PolicyAnesthesia services reimbursement and billing guidelines

Policy CodePolicy N/A

Change TypeReimbursement and coding updates (material)

Effective Date03/06/2026

Next Review DateN/A

Key ActionAppend the appropriate anesthesia HCPCS modifier to each anesthesia service code; services submitted without a modifier will be denied.

SourceLink

POLICY UPDATE CHANGES

Anesthesia modifier QZ reimbursement will change from 100% to 85% of the provider's applicable Fee Schedule allowed amount for dates of service on and after March 6, 2026.

Modifier 23 details were added and the Modifier 23 policy is archived effective April 2, 2026.

Policy now specifies that procedure code 01996 does not require an anesthesia modifier effective November 24, 2024.

Related Services section now indicates that an E&M service one day preoperatively, on the same day of, or one day postoperatively to an anesthesia service is included in the anesthesia service.

100% -> 85%QZ reimbursement change

85%QZ reimbursement level after 03/06/2026

01967, 01996, 00100-01992Example procedure codes

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AA/AD/QK/QX/QY/QZ/23

Recognized modifiers

11/24/202401996 modifier exception effective

Anesthesia Coverage Criteria

inv-01: Coverage criteria for anesthesia services

Covered when ALL of the following criteria for calculation, inclusions, modifier usage, and exceptions are met:

ALL of the following

Standard calculation: total anesthesia minutes divided by 15 and rounded to the nearest whole hundredth decimal point using standard rounding methodology (0.5 unit or more rounded up; 0.4999 unit or less rounded down).
Obstetrical epidural anesthesia (code 01967): first 60 anesthesia minutes divided by 20, remaining minutes divided by 30; the resulting units are combined and rounded to the nearest whole hundredth.

Definition of anesthesia time and attendance: anesthesia time begins when the anesthesiologist is first in attendance for induction and ends when the patient leaves the operating room or delivery room; time spent in the recovery room is included in anesthesia base units. For an encounter to qualify as 'anesthesia attendance' (not standby) all of the following must occur: service requested by the attending physician; anesthesiologist documents presence for the entire procedure and provided usual services except actual administration of anesthetic agent; attendance is medically necessary for the procedure and patient's condition.

ALL of the following

Local anesthesia is considered integral to the surgical procedure and is not separately reimbursed.
Anesthesia time is not required for nerve blocks reimbursed on relative value units only.
A pre-anesthesia evaluation when the procedure is delayed is integral to subsequent anesthesia services; if surgery is canceled the pre-anesthesia evaluation may be covered as a hospital or office visit (to the extent indicated).

ALL of the following

When modifier QY (medical direction of one CRNA) or QK (medical direction of 2–4 CRNAs) is used, physician reimbursement may be adjusted to reflect 50% of the provider's applicable Fee Schedule allowed amount as described in policy.
When CRNA provides service without medical direction (QZ), effective dates of service on and after March 6, 2026 reimbursement will change from 100% to 85% of the provider's applicable Fee Schedule allowed amount.

ALL of the following

Qualifying circumstance/add-on codes (99100–99140) may be applied when indicated and documented for extraordinary conditions or operative risk, but these codes are identified as Medicare Status B and are not eligible for reimbursement under this policy.

inv-02: Anesthesia coverage and billing rules

Billing and reimbursement criteria for anesthesia services and related care:

ALL of the following

Evaluation and management (E&M) services submitted one day preoperatively, on the same date of service, or one day postoperatively are included in the global anesthesia service and are not separately reimbursed when the anesthesia procedure has a global day period of 'XXX' per CMS; such E&M services are considered part of the global anesthesia service.
A pre-anesthesia evaluation when the procedure is delayed is integral to the subsequent anesthesia service and is not considered a separate procedure; when surgery is canceled the pre-anesthesia evaluation may be billed/covered as a hospital or office visit as appropriate.

ALL of the following

Procedure code 01996 (daily hospital management of epidural or subarachnoid continuous drug administration) does not require an anesthesia modifier effective November 24, 2024.

Codes, Modifiers, and Time Reporting

Highlighted procedure codesCPTCovered

01967	Neuraxial labor analgesia/anesthesia for planned vaginal delivery (this includes repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor)
01996	Daily hospital management of epidural or subarachnoid continuous drug administration (does not require an anesthesia modifier effective Nov 24, 2024)

Sedation codesCPT

99151-99157	Moderate (conscious) sedation services (initial and add-on codes for various provider relationships and time increments)
99155-99157	Moderate sedation services provided by a physician or other qualified healthcare professional other than the one performing the diagnostic or therapeutic service; includes initial and add-on 15-minute increments

Qualifying circumstance codesCPTNot Covered

99100-99140

Qualifying circumstances (add-on) codes (e.g., +99100, +99116, +99135, +99140); identified as Medicare Status B and not eligible for reimbursement

Modifier exceptionsCPTCovered

01996

Does not require an anesthesia modifier as of 11/24/2024

Anesthesia time unit calculation — inv-06

Standard time unit calculationTotal anesthesia minutes divided by 15; result rounded to the nearest hundredth using standard rounding (≥ .5 round up; ≤ .4999 round down).

Obstetrical epidural (01967) calculationFor OB anesthesia: first 60 minutes divided by 20, remaining minutes divided by 30; combined units are then rounded to the nearest hundredth using standard rounding rules.

Unit basisAll time-based anesthesia reimbursements are calculated on a four-unit hour unless otherwise noted.

Moderate sedation time reporting — inv-07

Increment reportingModerate (conscious) sedation codes are reported in 15-minute time increments per CPT guidance.

Billing Requirements and Provider Guidance

Denial Risk

Modifier requirement and denial risk

An appropriate anesthesia HCPCS modifier is required to be added to each anesthesia service code (codes 00100 - 01992, 01999) submitted to identify the level of the provider who rendered the service (for example, Certified Registered Nurse Anesthetist, resident physician, supervising or directing physician anesthesiologist). Reimbursement of the anesthesia service may be adjusted based on the specific modifier submitted. Anesthesia services/codes submitted without a modifier will be denied reimbursement. The Plan recognizes the following modifiers when appended to an anesthesia service, to identify the provider who rendered the anesthesia service(s):

Billing Rule

Related Services bundling

An E&M service provided one day preoperatively, on the same day as, or one day postoperatively to an anesthesia service is considered related and is included in the anesthesia service (i.e., such E&M services are bundled into the anesthesia service and not separately reimbursed).

Definitions and Modifier Notes

Definition of Anesthesia attendance — inv-13

Trigger for attendanceAnesthesia attendance is considered when the service is requested by the attending physician.

Documentation requirementAnesthesiologist must document presence for the entire procedure and that usual services were provided except actual administration of the anesthetic agent.

Medical necessityAttendance must be medically necessary for the patient’s surgical procedure and condition; otherwise it may be considered standby and not reimbursed.

Physical Status Modifiers (P1-P6) — inv-14

Modifier setPhysical Status Modifiers include P1, P2, P3, P4, P5, and P6 and may be added to anesthesia services when warranted.

PurposeThese modifiers distinguish between various levels of patient complexity for anesthesia services.

Policy Summary

PayerPremera Bluecross

PolicyAnesthesia services reimbursement and billing guidelines

Policy CodePolicy N/A

Change TypeReimbursement and coding updates (material)

Effective Date03/06/2026

Next Review DateN/A

Key ActionAppend the appropriate anesthesia HCPCS modifier to each anesthesia service code; services submitted without a modifier will be denied.

SourceLink

On This Page

An appropriate anesthesia modifier is required on anesthesia service claims (00100–01992, 01999) except where specific exceptions (e.g., 01996 effective 11/24/2024) apply; missing required modifiers may result in denial of reimbursement.

Modifier QZ reimbursement will be paid at 85% of the provider's applicable Fee Schedule allowed amount for dates of service on and after March 6, 2026; providers should apply the QZ modifier per contractual and coding guidance when applicable.

ALL of the following

When multiple surgical procedures are performed under a single anesthetic, report only the anesthesia code with the highest base value and combine the total anesthesia time when calculating time-based units; see Codes/Coding Guidelines for reporting details.

ALL of the following

Modifier 23 details have been added into this policy; the separate Modifier 23 policy is archived effective April 2, 2026.
Archived Anesthesia Modifier policy was removed from the cross-reference section and modifier-specific details were incorporated into this policy.

ALL of the following

Obstetrical anesthesia: 01967 (neuraxial labor analgesia/anesthesia for planned vaginal delivery).
Moderate/conscious sedation and qualifying circumstance codes are listed in the policy (see codes 99151–99157 and 99100–99140); qualifying circumstance add-on codes 99100–99140 are identified as not eligible for reimbursement.

ALL of the following

Exceptions to modifier requirements may be made where specifically identified (e.g., 01996 effective 11/24/2024) or as otherwise dictated by provider contract; failure to follow modifier requirements may result in claim denial, audit, or contractual remedies per Plan discretion.

ALL of the following

Effective November 24, 2024: code 01996 does not require an anesthesia modifier.
Effective March 6, 2026: reimbursement for services reported with modifier QZ will be paid at 85% of the provider's applicable Fee Schedule allowed amount.

Documentation threshold

More than half of the reported time (8 minutes) must be provided and documented to report moderate sedation codes.

Provider relationshipUse codes 99151–99153 when the sedation is provided by the same clinician performing the procedure; use 99155–99157 when provided by a different clinician.

Modifier QZ reimbursement percentage — inv-08

Effective reimbursement levelReimbursement for services reported with modifier QZ will be paid at 85% of the provider's applicable Fee Schedule allowed amount for dates of service on and after March 6, 2026.

Prior reimbursement implicationModifier QZ reimbursement changes from the prior 100% level to 85% effective 03/06/2026.

ScopeApplies to services billed with the QZ modifier as documented in the policy updates section.

E&M services billed 1 day pre-op, same day, or 1 day post-op to an anesthesia service are bundled and included in the anesthesia payment.

Note

Anesthesia modifier exception for 01996

Exception: Effective November 24, 2024, procedure code 01996 does not require an anesthesia HCPCS modifier and should be reported without an anesthesia modifier per the policy exception.

01996 — no anesthesia modifier required effective 2024-11-24

Billing Rule

Modifier QZ reimbursement change

Effective dates of service on and after March 6, 2026, reimbursement for modifier QZ (CRNA without medical direction) will be paid at 85% of the provider's applicable Fee Schedule allowed amount.

Modifier QZ reimbursement = 85% of applicable Fee Schedule for DOS on/after 2026-03-06

Impact on unitsAdditional unit values may be allowed for some physical status modifiers as recommended by the ASA Relative Value Guide.

Related Services (E&M bundling) definition — inv-15

Bundling ruleEvaluation and management (E&M) services one day preoperative, on the same date of service, or one day postoperative are included in the anesthesia service and are not separately reimbursed.

Pre-anesthesia evaluationA pre-anesthesia evaluation performed when a procedure is delayed is considered integral to the anesthesia service; if surgery is canceled the visit may be covered as a hospital or office visit per policy rules.

Related CPT referencesRelated Services and moderate sedation descriptions align with CPT code guidance and the policy’s Related Care section.

QZ modifier definition and reimbursement note — inv-16

Modifier definitionModifier QZ identifies CRNA/Anesthetist Assistant services without medical direction or supervision by an anesthesiologist.

Reimbursement change effective 03/06/2026For dates of service on or after March 6, 2026, services reported with modifier QZ will be reimbursed at 85% of the provider’s applicable Fee Schedule allowed amount (was 100% prior to this date).

Policy placementThe policy text adds the QZ reimbursement statement to the Related Care/Modifiers section and removes the archived Anesthesia Modifier policy from cross references.