ModifiedUnitedHealthcarePolicy 2026R0032A

Anesthesia Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans and Individual Exchangeopen_in_new

UnitedHealthcare Commercial and Individual Exchange reimbursement policy governing anesthesia services billed on CMS-1500 (and when specified UB04), including coding, modifiers, time reporting, bundling rules, reimbursement formulas, qualifying circumstances, obstetric anesthesia, and related billing guidance.

Policy Summary

PayerUnitedHealthcare

PolicyAnesthesia Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans and Individual Exchangeopen_in_new

Policy CodePolicy 2026R0032A

Change TypeRevisions to bundling, modifiers, reimbursement formula, obstetric anesthesia, definitions, and code lists

Effective Date

Next Review Date

Key ActionSubmit anesthesia services with CPT codes 00100-01999 (excluding 01953 and 01996) with a required anesthesia modifier in the first modifier position and report anesthesia time in one-minute increments.

SourceLink

POLICY UPDATE CHANGES

Anesthesia Services Bundled into HCPCS Procedural Codes Section Revised (history entry 02/15/2026) and earlier history entries updated/archived

Modifiers, Reimbursement Formula, Obstetric Anesthesia Services, Definitions, and Question and Answers Section Revised (history entry 10/01/2025)

Updated Procedural or Pain Management Codes Bundled into Anesthesia and Procedural or Pain Management Bundled Codes Allowed with Modifiers (history entry 03/30/2025)

00100-01999Anesthesia CPT code range

4Qualifying circumstance codes (no extra units)

435Neuraxial labor analgesia cap (minutes)

6Primary anesthesia modifiers listed

Policy overview and scope

This UnitedHealthcare reimbursement policy (Policy Number 2026R0032A) for Anesthesia reimbursement for services billed on CMS-1500 (UnitedHealthcare Commercial and Individual Exchange) aligns UnitedHealthcare methodology with the ASA Relative Value Guide (RVG), ASA CROSSWALK, and CMS NCCI Policy Manual and CMS Physician Fee Schedule. It defines requirements for reporting anesthesia CPT codes (00100-01999 with 01953 and 01996 excluded from anesthesia services), required anesthesia modifiers and their modifier percentages, time reporting in one-minute increments, Base Unit values, the Standard Anesthesia Formula (with and without AD), bundling rules for procedural/pain management and HCPCS mappings, and applicable claim forms (CMS-1500 and UB04 when specified). The policy applies to UnitedHealthcare Commercial and Individual Exchange products and all physicians and Other Qualified Health Care Professionals submitting CMS-1500 (and when specified UB04) claims.

Policy Metadata

Policy Number2026R0032A

SubjectAnesthesia reimbursement for services billed on CMS-1500

PayerUnitedHealthcare

ScopeUnitedHealthcare Commercial and Individual Exchange reimbursement policy governing anesthesia services billed on CMS-1500 (and when specified UB04), including coding, modifiers, time reporting, bundling rules, reimbursement formulas, qualifying circumstances, obstetric anesthesia, and related billing guidance.

StatusMODIFIED

Last review2026-02-15

Has material changetrue

Coverage criteria and rules for anesthesia services

Anesthesia services definition and reporting

Anesthesia services must be submitted and reported according to the following requirements.

Anesthesia CPT code range: Submit anesthesia services with CPT anesthesia codes in the range 00100-01999. Note: CPT codes 01953 and 01996 are excluded from this anesthesia services range and are not considered time‑based anesthesia services.

Required first‑position anesthesia modifier: All anesthesia services (including Monitored Anesthesia Care) must be submitted with a required anesthesia modifier in the first modifier position to identify whether the service was personally performed, medically directed, or medically supervised. Examples and modifier reimbursement percentages: AA = 100% (Anesthesiologist personally performed); AD = 100% (Anesthesiologist supervising more than 4 CRNAs); QK = 50% (Anesthesiologist supervising 2–4 CRNAs); QX = 50% (CRNA medically directed by Anesthesiologist); QY = 50% (Anesthesiologist supervising 1 CRNA); QZ = 85% (CRNA personally performed). UnitedHealthcare will adjust the Allowed Amount by the Modifier Percentage.

Time reporting in one‑minute increments: Time‑based anesthesia services must be reported with actual Anesthesia Time in one‑minute increments (e.g., one hour = 60 minutes). Do not add time for blocks placed before induction or after emergence when placed without extending anesthesia time per ASA guidance.

Code tables and modifier guidance

Billing, documentation and submission requirements

Billing Rule

Submit anesthesia codes and modifiers correctly

Submit anesthesia services with a CPT anesthesia code in the range 00100-01999 (01953 and 01996 excluded), place the required anesthesia modifier in the first modifier position, and report anesthesia time in one‑minute increments (use minutes).

Affected codes: 00100-01999 (exclude 01953, 01996)

Billing Rule

Use correct modifier to determine reimbursement percentage

Append the appropriate anesthesia performance modifier (AA, AD, QK, QX, QY, QZ). UnitedHealthcare adjusts the allowed amount by the modifier percentage specified in policy (see modifier table for each modifier's reimbursement percentage).

AA — 100%
AD — 100%

Key definitions

Definitions

Anesthesia TimeBegins when Anesthesia Professional prepares patient for induction and ends when no longer in personal attendance; reported in one-minute increments.

Base ValueNumber of units representing the base unit value per anesthesia code; includes usual pre/postoperative visits and routine monitoring; excludes placement of arterial/central/pulmonary artery catheters and TEE.

Standard Anesthesia FormulaEither the Standard Anesthesia Formula with or without modifier AD used to calculate reimbursement: without AD = ([Base Unit Value + Time Units] x Conversion Factor) x Modifier Percentage; with AD = ([Base Unit Value of 3 + 1 additional unit if present during induction] x Conversion Factor) x Modifier Percentage.

Same Individual Physician or Other QHPThe same individual rendering health care services reporting the same Federal Tax Identification number.

Same Specialty Physician or Other QHPPhysicians and/or Other QHPs of the same group and same specialty reporting the same Federal Tax Identification number.

Frequently asked questions

FAQs

Policy revision timeline

03/30/2025revised (code list updates)

Updated Procedural or Pain Management Codes Bundled into Anesthesia and Procedural or Pain Management Bundled Codes Allowed with Modifiers (code list updates).

10/01/2025revised (multiple section revisions)

Modifiers, Reimbursement Formula, Obstetric Anesthesia Services, Definitions, and Questions and Answers sections revised (multiple section revisions).

02/15/2026revised (HCPCS procedural bundling section)Latest

Policy Summary

PayerUnitedHealthcare

PolicyAnesthesia Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans and Individual Exchangeopen_in_new

Policy CodePolicy 2026R0032A

Change TypeRevisions to bundling, modifiers, reimbursement formula, obstetric anesthesia, definitions, and code lists

Effective Date

Next Review Date

SourceLink

On This Page

Physical status modifiers informational only: Physical status modifiers (P1–P6) are considered informational and are not used for additional reimbursement.

Qualifying circumstances excluded from extra units: Qualifying circumstance codes (99100, 99116, 99135, 99140) identify conditions that significantly affect the anesthetic service but UnitedHealthcare does not allow additional units for these qualifying circumstance codes.

Qualifying circumstances

Qualifying circumstance codes and payment rule.

Qualifying circumstance codes: 99100, 99116, 99135, 99140.

Payment rule: Consistent with CMS guidance, UnitedHealthcare does not allow additional anesthesia units or other additional reimbursement for qualifying circumstance codes; these codes are informational for identifying altered circumstances only.

Multiple or duplicate anesthesia services

Rules for multiple, duplicate, and concurrent anesthesia services, and modifiers for distinct sessions.

Multiple procedures during a single anesthesia administration: When multiple surgical procedures are performed during a single anesthesia administration, report only the single anesthesia code with the highest Base Unit Value. Report the combined total anesthesia time for all procedures performed on the same patient on the same date of service, even if performed by the same or different physicians/Other QHPs. Add‑on anesthesia codes (01953, 01968, 01969) are exceptions and addressed in other sections.

Duplicate anesthesia codes: When the same anesthesia code is reported more than once for the same patient on the same date of service by the same or different providers, UnitedHealthcare will reimburse only the first submission of that code.

Simultaneous MD and CRNA services: Anesthesia administration services may be rendered simultaneously by an MD and a CRNA during the same operative session. Reimbursement is split (50% of the Allowed Amount each) when reported with appropriate modifiers (for example QK or QY for the MD’s supervising modifier and QX for the CRNA directed by the MD), per the modifier reimbursement percentages.

Separate operative sessions same day: If an anesthesia administration is provided during a different operative session on the same date as a previous operative session, UnitedHealthcare will reimburse one additional anesthesia administration when appended with modifier 59, 76, 77, 78, 79 or XE. For that additional session, report only the single anesthesia code with the highest Base Unit Value and report the anesthesia time for that distinct session.

Anesthesia services bundled into procedural/pain management services

Anesthesia services that are bundled into payment for procedural or pain management services and guidance on modifier 47 usage.

Bundling principle: UnitedHealthcare follows authoritative methodologies (ASA RVG, CMS NCCI, other referenced sources) to determine when procedural or pain management services are integral (bundled) to anesthesia services and when anesthesia services are integral to procedural services. Codes identified as bundled (integral) are not separately reimbursable when performed by the Same Individual Physician or Other QHP on the same date of service (Same Individual = same Federal Tax Identification number).

Examples of bundled identifiers: Services in the CMS National Physician Fee Schedule with status indicator B (Bundled) or T (Injections), and services not separately reimbursed with anesthesia services per CMS NCCI Policy Manual Chapter 2, are considered bundled.

Modifier 47 and other modifiers: If CPT modifier 47 (surgical procedure performed under local anesthesia without sedation) or HCPCS modifiers GC, G8, G9, QS, or modifiers 23, 76, 77, 78, 79, XE are appended as applicable, no additional reimbursement is allowed above the usual fee for that service unless guidance elsewhere in this policy specifies otherwise. Some listed procedural or pain management codes may be considered distinct and separately reimbursable when appropriately modified (for example modifier 59, XE, XU, XS, XP) — see Bundling rules and the Procedural or Pain Management Services Bundled in Anesthesia Services list for specifics.

Daily hospital management (CPT 01996)

Daily hospital management (CPT 01996) reimbursement and bundling guidance.

01996 not an anesthesia service: CPT 01996 is excluded from the anesthesia service range and is not considered a time‑based anesthesia service per ASA RVG®; it is addressed separately as Daily Hospital Management.

Separate reimbursement for 01996: CPT 01996 (daily hospital management) may be separately reimbursable when reported as described by ASA and payer guidelines. However, 01996 is not reported as a time‑based anesthesia code and is excluded from the 00100‑01999 anesthesia time reporting rules.

Bundling with pain management: When daily hospital management or other pain management services are integral to an anesthesia or procedural service under applicable edits or authoritative guidance, they are not separately reimbursable. Follow the Procedural or Pain Management Services Bundled rules and CCI editing where applicable.

Neuraxial labor analgesia (CPT 01967) and obstetric add‑ons

Neuraxial labor analgesia and obstetric add‑on codes rules.

Primary neuraxial labor analgesia cap: CPT 01967 (neuraxial labor analgesia/anesthesia for planned vaginal delivery) and associated obstetric anesthesia reporting are subject to a 435‑minute cap for the reported anesthesia time for the primary neuraxial labor analgesia service.

Obstetric add‑on codes 01968/01969: Add‑on codes 01968 and 01969 (for additional time/complexity related to obstetric anesthesia) are separate add‑on codes and may be reported in addition to 01967 where appropriate. The time for add‑on codes must be reported separately and not combined with the primary 01967 time when submitting claims.

Handling add‑ons relative to cap: The 435‑minute cap applies to the primary neuraxial labor analgesia code (01967); follow guidance in this policy for how add‑on codes interact with the cap and for correct separate time reporting for 01968 and 01969.

Modifier 22 consideration

Modifier 22 consideration for increased procedural services and UnitedHealthcare’s mechanism for adjusting base units.

Eligibility for Modifier 22: Modifier 22 (increased procedural services) may be considered when the usual Base Unit Value for the anesthesia code is less than 5 (< 5) and documentation demonstrates that the service required significantly greater work than typically required.

Documentation requirement: The provider must submit supporting clinical documentation to justify Modifier 22. Documentation should clearly describe the additional work, effort, or complexity beyond the usual service.

Reimbursement mechanism: UnitedHealthcare’s process for Modifier 22 requests allows consideration of additional base units to reach a total of 5 base units when justified by documentation. If approved, UnitedHealthcare adjusts the Base Unit Value used in the Standard Anesthesia Formula so the total Base Units equal 5, and applies the applicable Modifier Percentage per the required anesthesia modifier.

Note: Physical status modifiers (P1–P6) are informational and do not substitute for documentation supporting Modifier 22; qualifying circumstance codes do not entitle additional units.

Bundling rules: Procedural or pain management services

Procedural and pain management services that are considered bundled into anesthesia services and exception guidance when modifiers indicate distinct services.

Typical bundled services: Procedural or pain management services identified as bundled include those listed in authoritative sources and the Procedural or Pain Management Services Bundled list (see policy). Codes with CMS status indicator B (Bundled) or T (Injections) and services not separately reimbursed per CMS NCCI Policy Manual Chapter 2 are examples of bundled services.

Distinct service exceptions with modifiers: Some codes listed as bundled may be considered distinct and separately reimbursable when an appropriate modifier indicating a distinct procedural service is appended (for example modifier 59 or the NCCI modifier set XE, XU, XS, XP). When such a modifier is valid and supported by documentation, the procedural or pain management code may be considered separately payable.

Same Individual rule: Procedural/pain management services that are integral to anesthesia services are not separately reimbursable when performed by the Same Individual Physician or Other QHP (same Federal Tax Identification number) on the same date of service.

Pre‑/postoperative visits

Preoperative and postoperative visit reimbursement guidance.

E/M visits included with anesthesia: Routine preoperative and postoperative E/M visits are considered part of the anesthesia service and are not separately reimbursable when rendered as part of the anesthesia episode.

Critical care exceptions: Critical care services reported with CPT codes 99291 and 99292 are separately reimbursable when appropriately documented and not considered part of the anesthesia administration. Distinguish routine pre/postoperative E/M care from critical care time when submitting claims.

Billing Rule

Report distinct procedural services with modifier 59/XE/XU

When a procedural/pain management code that is normally bundled into anesthesia represents a separate encounter, append modifier 59, XE or XU to indicate a distinct procedural service per the policy mappings. If not appended or mappings do not support distinct encounter, the code is considered bundled and not separately reimbursable.

Use 59, XE or XU to indicate distinct procedural service per the Bundled vs Allowed-with-modifier lists

Billing Rule

Duplicate code reimbursement limitation

UnitedHealthcare will reimburse only the first submission of the same anesthesia code for the same patient on the same date. Exceptions for distinct subsequent operative sessions may be reimbursed when the later service is appended with an appropriate modifier (59, 76, 77, 78, 79 or XE). Simultaneous MD and CRNA administration is handled via appropriate modifiers and split reimbursement.

Only first submission reimbursed for duplicate same-code on same date
Exceptions require modifiers: 59, 76, 77, 78, 79, or XE
Simultaneous MD and CRNA: report modifiers (QK/QY and QX) per policy

Documentation Required

Modifier 22 supporting documentation

Modifier 22 may be considered only for anesthesia services with a Base Unit Value less than 5. To request additional reimbursement, submit a paper CMS claim with supporting documentation. If approved, additional base units are added so the total base units equal 5.

Eligibility: Base Unit Value < 5
Submit supporting documentation via paper CMS claim
Reimbursement adds base units so total base units = 5

Billing Rule

CRNA reporting

CRNA services should be reported with modifier QX or QZ and must be reported under the supervising physician's name or the employer/entity name under which the CRNA is contracted. If the CRNA is individually credentialed/contracted by UnitedHealthcare, report under the CRNA as instructed.

Report CRNA with QX or QZ
Report under supervising physician or employer/entity unless individually contracted

Billing Rule

Anesthesia assistants reporting

Anesthesia Assistants (AAs) are reported consistent with CMS: when medically directed by a physician, the AA reports the anesthesia service with modifier QX and the supervising physician reports the same service with modifier QK, QY or AD as appropriate. UnitedHealthcare aligns AA reimbursement with CRNA levels when medical direction applies.

AA reports with QX when medically directed
Supervising physician reports same service with QK, QY or AD

Billing Rule

Time reporting on paper claims

On CMS 1500 paper claims (02-12 format) report anesthesia minutes in item 24G (Days or Units) as minutes, left-justified with no leading zeros. For electronic claims the equivalent is the 837P SV104 service unit count (Service Unit Count maps to 24G).

Paper: CMS 1500 item 24G — enter minutes left-justified (no leading zeros)
Electronic: map to 837P SV104 Service Unit Count

Anesthesia Services Bundled into HCPCS Procedural Codes section revised; History notes prior entries before 2/15/2024 archived (material change).