CurrentUnitedHealthcarePolicy N/A

Anesthesia Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Planopen_in_new

UnitedHealthcare Community Plan Medicaid reimbursement policy governing professional anesthesia services (CPT 00100-01999 excluding 01953 and 01996) billed on CMS-1500 or electronic equivalent, including modifiers, time reporting, bundling rules, state exceptions, and reimbursement formulas.

Policy Summary

PayerUnitedHealthcare

PolicyAnesthesia Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Planopen_in_new

Policy CodePolicy N/A

Change TypeMultiple version updates (material and non-material)

Effective Date

Next Review Date

Key ActionAll anesthesia services including Monitored Anesthesia Care must be submitted with a required anesthesia modifier in the first modifier position; modifier percentage will adjust Allowed Amount.

SourceLink

POLICY UPDATE CHANGES

Anesthesia Services Bundled into HCPCS Procedural Codes section updated.

Annual Review: Version update; History entries prior to 2/1/2024 archived.

State Exceptions section: Idaho added.

State Exceptions section: California removed.

Reimbursement Guidelines: Procedural or Pain Management Codes Bundled into Anesthesia and Procedural or Pain Management Bundled Codes Allowed with Modifiers Codes table updated.

State Exceptions section: Wisconsin updated.

State Exceptions section: Indiana updated.

Policy Implemented by UnitedHealthcare Community & State.

00100-01999Anesthesia CPT range governed

>50

Policy summary and scope

This policy governs UnitedHealthcare Community Plan Medicaid reimbursement for professional anesthesia services billed on CMS-1500 forms or the electronic 837P equivalent and is developed using the ASA Relative Value Guide (RVG®), ASA CROSSWALK®, CMS National Correct Coding Initiative (NCCI) guidance and the CMS National Physician Fee Schedule. Anesthesia services (CPT 00100-01999, excluding 01953 and 01996) are reimbursed using the Standard Anesthesia Formula based on Base Unit Values (per ASA assignments), actual anesthesia time reported in one-minute increments to derive time units, an applicable conversion factor, and adjustment by the reported anesthesia modifier percentage (AA/AD/QK/QX/QY/QZ etc.).

Key policy header facts

PayerUnitedHealthcare Community Plan

PolicyAnesthesia professional reimbursement

Policy NumberN/A

Effective Date

StatusCURRENT

ScopeUnitedHealthcare Community Plan Medicaid reimbursement policy governing professional anesthesia services (CPT 00100-01999 excluding 01953 and 01996) billed on CMS-1500 or electronic equivalent, including modifiers, time reporting, bundling rules, state exceptions, and reimbursement formulas.

Anesthesia Time reporting incrementone-minute increments

Epidural time limitno more than 360 minutes (24 units) for a vaginal or cesarean delivery (Florida-specific)

Anesthesia coverage and reimbursement rules

Bundling rules for procedural/pain management codes

Procedural/pain management codes identified as bundled are not separately reimbursable unless appropriately marked as distinct encounters

Bundle mapping examples: Specific bundled code mappings and lists are maintained in the policy (see Procedural or Pain Management Codes Bundled into Anesthesia tables)

Refer to tables showing many CPT/HCPCS mappings

Daily hospital management (01996)

CPT 01996 daily hospital management reimbursement rules

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Code lists and modifier groups

Anesthesia CPT codes considered anesthesia servicesCPTCovered

00100-01999

Anesthesia services reimbursed as time-based using Standard Anesthesia Formula (excludes 01953 and 01996 as anesthesia services per policy)

Explicitly excluded from anesthesia service reportingCPTNot Covered

01953	Not considered an anesthesia service (not time-based) per ASA RVG®
01996	Not considered a time-based anesthesia service per ASA RVG® (daily management handled separately in policy)

Qualifying circumstance codes (no additional base units allowed)CPT

99100	Qualifying circumstance
99116	Qualifying circumstance
99135	Qualifying circumstance
99140	Qualifying circumstance

Altered circumstance / other modifiers referencedModifier

AA	Anesthesia performed personally by anesthesiologist
AD	Medical supervision by physician: more than four concurrent anesthesia procedures
QK	Medical direction of two, three, or four concurrent anesthesia procedures
QX	CRNA service with medical direction by a physician
QY	Medical direction of one CRNA by an anesthesiologist
QZ	CRNA service without medical direction
23	Unusual procedural services (no additional reimbursement above usual fee when appended to anesthesia/pain management per policy)
47	Surgical/procedural anesthesia performed by same physician (no separate anesthesia code used)
GC	Resident teaching physician (no additional reimbursement above usual fee when appended per policy)
G8	Monitored anesthesia care for deep sedation — no additional reimbursement above usual fee when appended per policy

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Procedural or Pain Management Codes Bundled into Anesthesia (selected list from policy)mixedNot Covered

0213T	Listed with mappings to other codes; bundled
0214T	Bundled mappings
0215T	Bundled mappings
0216T	Bundled mappings
0217T	Bundled mappings
0218T	Bundled mappings
36415	Bundled when reported with anesthesia per mapping
36416	Bundled when reported with anesthesia per mapping
36591	Bundled when reported with anesthesia per mapping
36592	Bundled when reported with anesthesia per mapping

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Anesthesia services bundled in procedural HCPCS codes (selected examples)HCPCSNot Covered

G0104	Mapped to various anesthesia CPT codes per policy (see list)
G0105	Mapped to various anesthesia CPT codes per policy
G0121	Mapped to various anesthesia CPT codes per policy
G0186	Mapped to various anesthesia CPT codes per policy
G0268	Mapped to various anesthesia CPT codes per policy
G0339	Mapped to various anesthesia CPT codes per policy
G0340	Mapped to various anesthesia CPT codes per policy
G0412	Mapped to various anesthesia CPT codes per policy
G0413	Mapped to various anesthesia CPT codes per policy
G0448	Mapped to various anesthesia CPT codes per policy

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Epidural/Subarachnoid Injection CPT Codes (allowed separately with modifier when for postoperative pain)CPTCovered

62320	Epidural or subarachnoid injection; lumbar/caudal; single injection
62321	...with imaging guidance
62322	continuous infusion
62323	thoracic; single injection
62324	thoracic; single injection with imaging guidance
62325	thoracic; continuous infusion
62326	cervical or thoracic; single injection
62327	cervical or thoracic; continuous infusion

Modifiers Required for Distinct Procedural ServiceModifier

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

The code tables in this policy present selected examples of procedural, pain management and HCPCS codes that the policy identifies as bundled into or mapping to anesthesia services; they are not exhaustive. Consult the ASA CROSSWALK® and CMS NCCI/Physician Fee Schedule for definitive crosswalks and bundling edits, and review applicable state exceptions (which may alter modifier reimbursement or bundling) before final billing. Note that many nerve block codes are treated as bundled when reported with anesthesia unless reported as a distinct procedural service by appending modifier 59, XE or XU.

Billing, documentation, and submission requirements

Billing Rule

Submit anesthesia modifier in first modifier position

Submit an anesthesia modifier in the first modifier position on all anesthesia claims. These modifiers indicate whether the service was personally performed, medically directed, or medically supervised and determine the modifier percentage applied to the allowed amount.

AA, AD, QK, QX, QY, QZ, XU

Billing Rule

Report anesthesia time in minutes

Report actual anesthesia time in minutes on claims. Time must be submitted in one-minute increments (e.g., one hour = 60 minutes). For electronic claims, map anesthesia time to the appropriate field (837P: SV104) and for paper claims record total minutes in item 24G. Do not include time spent placing blocks before induction or after emergence when those blocks are outside the anesthesia administration period.

Paper claims: Enter anesthesia minutes in CMS-1500 box 24G

Claim form and electronic mapping instructions

Reporting Anesthesia Time on Claims

Instructions for how anesthesia minutes/units should be reported on paper (CMS 1500 02-12) and electronic (837P) claims:

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Operational notes: on CMS-1500 (02-12) paper claims enter anesthesia minutes in field 24G, left-justify numeric entry and use a decimal point for any fractional unit; report actual anesthesia time in one-minute increments. For electronic submission map paper field 24G/Days or Units to 837P loop 2400 element SV104 (Service Unit Count) per X12 837 Professional Version 5010/5010A1 technical guidance. Use the updated CMS-1500 (02-12) form and NUCC resources for further form instructions.

Special cases: teaching, monitors, epidurals, obstetrics

Anesthesia Teaching Services

Guidance on reporting anesthesia teaching services:

Teaching reimbursement: Reimbursement for anesthesia teaching services is based on the specific modifier reported (see Reimbursement Formula and Modifiers sections)

Refer to HHS Federal Register (Nov 25, 2009) for reporting anesthesia teaching services guidance

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Brain Function Monitor for Intraoperative Awareness

Brain function monitor not separately reportable:

Key terms

Definitions (brief)

Allowable AmountDollar amount eligible for reimbursement determined by contracted rate, reasonable charge, or billed charges as applicable.

Anesthesia TimeBegins when Anesthesia Professional prepares patient for induction in OR or equivalent area and ends when no longer in personal attendance; involves continuous actual presence.

Anesthesia ProfessionalAnesthesiologist, CRNA, Anesthesia Assistant (AA), or other qualified individual working independently or under medical supervision.

Base Unit ValueUnits representing the Base Value (per code) of usual anesthesia services excluding time and modifying units.

Conversion FactorIncremental multiplier rate defined by contracts or industry standards; for non-network physicians based on recognized national source.

Definitive SourceSource containing exact codes, modifiers or very specific instruction.

Frequently asked questions

FAQs

Operational Callouts

Billing Rule

CRNA reporting

Billing Rule

Reporting minutes on claims

Billing Rule

Epidural/subarachnoid distinct reporting (CPT 62320‑62327)

Policy updates and material changes

2/20/2026revisedLatest

Anesthesia Services Bundled into HCPCS Procedural Codes section updated.

2/1/2026revised

Annual Review: Version update; History entries prior to 2/1/2024 archived.

11/16/2025revised

State Exceptions section: Idaho added.

Policy Summary

PayerUnitedHealthcare

PolicyAnesthesia Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Planopen_in_new

Policy CodePolicy N/A

Change TypeMultiple version updates (material and non-material)

Effective Date

Next Review Date

SourceLink

On This Page

Billing Rule

Do not separately bill bundled procedural/pain codes unless distinct modifiers appended

Do not separately bill procedural or pain management codes that are bundled into anesthesia services when performed by the same individual on the same date of service, unless a distinct procedural modifier is appropriately appended to indicate a separately reportable service.

Examples of code groups commonly affected: CPT nerve block/injection series (e.g., 62320-62327), listed bundled codes (64561, 82800, 82803, 82805, 82810, 85345, 85347, 85348)

Billing Rule

Duplicate anesthesia code reporting

When duplicate (same) anesthesia codes are reported for the same patient and date of service, only the first submission of that code will be reimbursed. If an MD and CRNA provide simultaneous anesthesia administration during the same operative session, report the appropriate QK/QY (medical direction) and QX (CRNA modifier) pairing (or QZ where applicable) to enable split reimbursement (typically 50% each when indicated).

Only first submission reimbursed for duplicate same-date same-code reporting
Simultaneous MD/CRNA: report QK or QY with QX (or QZ) to reflect split reimbursement

Documentation Required

Anesthesia notes to support Modifier AD presence

Document physician presence in the anesthesia record when using modifier AD to support the additional unit for physician presence during induction. Include notes that clearly describe the physician's activities and the time of presence to substantiate the AD modifier and the related additional unit.

Action: Document physician presence during induction to allow additional unit when modifier AD is reported

Billing Rule

CRNA reporting requirements and employer/supervising physician name rules

CRNAs must report the appropriate CRNA modifiers (QX or QZ) and follow employer/supervising physician naming rules on claims. Ensure the supervising or employing physician name is included where required to support modifier QX (medically directed by anesthesiologist) or QZ (CRNA service without medical direction).

Billing Rule

Use modifiers 59/XE/XU to indicate distinct epidural/subarachnoid injection service

Use modifier 59 or one of the XE/XU/XP modifiers to indicate a distinct epidural or subarachnoid injection service when reported separately from anesthesia services. This applies when CPT codes 62320-62327 are billed separately and meet distinct procedural reporting criteria.

Affected CPT codes: 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327

Documentation Required

Submit supporting documentation with paper claims when requested

When UnitedHealthcare requests supporting documentation for anesthesia claims submitted on paper, include the requested anesthesia record, operative note, and any documentation substantiating modifiers, anesthesia time, and supervising/performing provider relationships.