ModifiedUnitedHealthcarePolicy 2026R0032A

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

UnitedHealthcare reimbursement policy for anesthesia services billed on CMS-1500 (professional) for Commercial and Individual Exchange plans, governing coding, required modifiers, time reporting, reimbursement formulas, bundling rules, duplicate/multiple services, obstetric anesthesia, daily hospital management, qualifying circumstances, 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 and code lists

Effective Date

Next Review Date

Key ActionAppend the appropriate anesthesia modifier (AA, AD, QK, QX, QY, QZ) in the first modifier position for all anesthesia services; Allowed Amount will be adjusted by modifier percentage.

SourceLink

POLICY UPDATE CHANGES

Anesthesia Services Bundled into HCPCS Procedural Codes Section Revised.

Modifiers, Reimbursement Formula, Obstetric Anesthesia Services, Definitions, and Question and Answers Section Revised.

Updated Procedural or Pain Management Codes Bundled into Anesthesia and Procedural or Pain Management Bundled Codes Allowed with Modifiers.

00100-01999Anesthesia code range governed

435Neuraxial labor analgesia cap

4Qualifying circumstance codes

6Key anesthesia modifiers

Policy Overview

UnitedHealthcare aligns anesthesia reimbursement with the American Society of Anesthesiologists (ASA) Relative Value Guide and ASA CROSSWALK and applies CMS guidance (NCCI edits and the Physician Fee Schedule) for coding and edits; the policy governs anesthesia professional services billed on CMS-1500 (professional) for Commercial and Individual Exchange plans. It requires use of CPT anesthesia codes 00100-01999 (excluding 01953 and 01996), submission of a required anesthesia modifier in the first modifier position (e.g., AA, AD, QK, QX, QY, QZ), reporting of actual anesthesia time in one-minute increments, and reimbursement using the Standard Anesthesia Formula (with a special AD variant). The policy also addresses bundling rules between anesthesia and procedural/pain-management or HCPCS services, duplicate/multiple anesthesia reporting, special obstetric anesthesia rules including neuraxial labor analgesia time cap of 435 minutes and add-on handling (01968/01969 with 01967), and daily hospital management (CPT 01996) guidance.

Policy metadata

Policy number2026R0032A

Last review2026-02-15

Effective Date

Next review

Policy subjectAnesthesia professional services reimbursement (CMS 1500)

ScopeUnitedHealthcare reimbursement policy for anesthesia services billed on CMS-1500 (professional) for Commercial and Individual Exchange plans

Has material changetrue

Anesthesia Reporting & Reimbursement Rules

Anesthesia Services Reporting and Reimbursement

Anesthesia services billed on CMS-1500 must meet these coding and reporting rules:

Anesthesia code range and exclusions: Anesthesia services must be submitted with a CPT anesthesia code in the range 00100-01999, excluding 01953 and 01996.
01953 and 01996 are not considered time-based anesthesia services.
Required anesthesia modifier: All anesthesia services including Monitored Anesthesia Care must be submitted with a required anesthesia modifier in the first modifier position (e.g., AA, AD, QK, QX, QY, QZ).
UnitedHealthcare will adjust Allowed Amount by modifier percentage per table.
Anesthesia time reporting: Time-based anesthesia services must be reported with actual Anesthesia Time in one-minute increments.

Bundling and Separate Reimbursement Rules

ANY of the following

Procedural/pain management services are not separately reimbursable when performed by the Same Individual Physician or Other QHP on the same date of service. The Same Individual is the same individual rendering services and reporting the same Federal Tax Identification number.
Procedural or Pain Management Services Bundled in Anesthesia Services include: Services in the CMS National Physician Fee Schedule with status indicator B (Bundled) or T (Injections); services that are not separately reimbursed with anesthesia services per recognized authoritative sources (ASA RVG, CMS NCCI, and UnitedHealthcare interpretations).
Large enumerated list of procedural/pain-management codes identified as bundled (see Procedural or Pain Management Bundled Codes Allowed with Modifiers code group). These codes are considered integral to either the procedural service or the anesthesia service and are typically not separately payable when performed by the Same Individual.

Neuraxial Labor Analgesia & Obstetric Add-ons

Neuraxial Labor Analgesia and Obstetric Anesthesia

Special rules for neuraxial labor analgesia (CPT 01967) and obstetric add-ons:

01967 reimbursement and cap: Neuraxial labor analgesia (CPT 01967) is reimbursed based on Base Unit Value plus Time Units subject to a cap of 435 minutes.Time cap = 435 minutes
Obstetric add-on codes 01968/01969: Obstetric add-on codes 01968 and 01969 may be considered for reimbursement when billed with primary CPT 01967 (by the same or different individual physician/QHP) for the same member; time for add-on codes is reported separately and not added to 01967 time.
Time for add-on 01968/01969 reported separately and not added to time for 01967.
Examples: If 200 minutes reported for 01967 then 200 minutes added to base; if 500 minutes reported, capped to 435; if 01967 plus 01968 reported separately times aggregate accordingly per code.

Daily Hospital Management (CPT 01996)

Daily management of epidural/subarachnoid drug administration billing rules:

Daily Hospital Management (CPT 01996): CPT 01996 is separately reimbursable once per date of service (excluding the day of insertion) in CMS places of service 19, 21, 22, or 25. CPT 01996 is considered included in the pain management procedure if submitted on the same date of service by the Same Individual Physician or Other QHP.

01996 may be included in pain management when submitted by Same Individual Provider on same date; critical care codes 99291-99292 are separately reimbursable.

Billing Rule

CPT 01996 daily management

CPT 01996 (daily hospital management of epidural/subarachnoid drug administration) is reimbursable once per date of service (excluding the day of insertion) when billed in CMS places of service 19, 21, 22 or 25. If CPT 01996 is submitted on the same date by the Same Individual Physician or Other QHP with a pain management procedure, it is considered included in that pain management procedure and not separately payable.

Code Lists & Modifier Rules

Unsupported block type: object

Billing Rule

Use required anesthesia modifier in first position

Append the required anesthesia modifier in the first modifier position on all anesthesia service claims. UnitedHealthcare will adjust Allowed Amount by the modifier percentage shown in the required modifiers table.

AA — Anesthesiologist personally performed (100% Allowed Amount)
AD — Anesthesiologist supervising over 4 CRNAs (100% Allowed Amount)
QK — Anesthesiologist medically directing 2-4 concurrent procedures (50% Allowed Amount)
QX — CRNA medically directed by anesthesiologist (50% Allowed Amount)
QY — Anesthesiologist medically directing 1 CRNA (50% Allowed Amount)
QZ — CRNA personally performed (85% Allowed Amount)

Note

Billing & Provider Actions

High-priority billing rules

Documentation and claim submission specifics

Key Definitions

Definitions

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

Base ValueNumber of units representing usual anesthesia services excluding time; includes usual pre/postoperative visits and routine monitoring.

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.

Standard Anesthesia Formula([Base Unit Value + Time Units] x Conversion Factor) x Modifier Percentage; special AD variant: ([Base Unit Value of 3 + 1 additional unit if physician present during induction] x Conversion Factor) x Modifier Percentage.

Frequently Asked Questions

FAQs — physician-performed, cancellations, CRNA

FAQs — modifier 22 and remaining

Policy Revision History

2026-02-15material revisionLatest

Anesthesia Services Bundled into HCPCS Procedural Codes Section Revised

2025-10-01material revision

Modifiers, Reimbursement Formula, Obstetric Anesthesia Services, Definitions, and Question and Answers Section Revised

2025-03-30revision

Updated Procedural or Pain Management Codes Bundled into Anesthesia and Procedural or Pain Management Bundled Codes Allowed with Modifiers

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 and code lists

Effective Date

Next Review Date

Key ActionAppend the appropriate anesthesia modifier (AA, AD, QK, QX, QY, QZ) in the first modifier position for all anesthesia services; Allowed Amount will be adjusted by modifier percentage.

SourceLink

On This Page

Paper/electronic claim guidance provided; minutes reported as minutes in 24G or SV104.

Reimbursement formula: Time-based anesthesia services reimbursed using Standard Anesthesia Formula: ([Base Unit Value + Time Units] x Conversion Factor) x Modifier Percentage; special AD formula applies.

For AD: ([Base Unit Value of 3 + 1 Additional Unit if physician present during induction] x Conversion Factor) x Modifier Percentage.

Physical status modifiers (P1-P6) are informational and are not considered for additional reimbursement.

Modifiers G8/G9/GC/QS/23/47 etc. identify altered circumstances; no additional reimbursement allowed for some (23,47,GC,G8,G9,QS).

Multiple, Duplicate, and Subsequent Anesthesia Services

Reporting when multiple procedures or duplicate services occur:

Multiple procedures in single anesthesia: When multiple surgical procedures are performed during a single anesthesia administration, report only a single anesthesia code with the highest Base Unit Value and report the combined total anesthesia time.
Add-on anesthesia codes (01953, 01968, 01969) are exceptions as addressed elsewhere.
Duplicate code reimbursement: When duplicate (same) anesthesia codes are reported by the same or different physician or Other QHP for the same patient on the same date of service, UnitedHealthcare will reimburse only the first submission of that code.
Exception: MD and CRNA can each be reimbursed 50% by reporting QK or QY and QX modifiers.
Separate operative session on same day: If anesthesia administration is provided during a different operative session on the same day as a previous session, UnitedHealthcare will reimburse one additional anesthesia administration when appended with modifier 59, 76, 77, 78, 79 or XE.
As with initial, only single anesthesia code with highest Base Unit Value should be reported for each session.

Qualifying Circumstances

Qualifying circumstance codes and reimbursement impact:

Qualifying Circumstances: Qualifying circumstance codes are 99100, 99116, 99135 and 99140.

UnitedHealthcare does not allow additional units for qualifying circumstances codes.

When a procedural or pain management service that would otherwise be bundled is performed by the Same Individual but meets documentation and coding criteria to be reported as distinct, use modifier 59 or the CMS X{E,XP,XS,XU} modifiers (XE, XP, XS, XU) to indicate the service is distinct and separately reportable. UnitedHealthcare will consider reimbursement when appropriate modifiers and supporting documentation are submitted.

Surgeon-performed anesthesia: if the surgeon performs anesthesia services (CPT anesthesia codes reported by the surgeon) modifier 47 guidance applies (modifier 47 indicates surgeon-performed anesthesia) and no additional reimbursement is allowed above the usual fee for that surgical service unless otherwise specified by contract or plan design.

HCPCS-to-anesthesia mappings: UnitedHealthcare references the ASA CROSSWALK and other mapping tools to align HCPCS procedure codes to anesthesia codes for bundling determinations. Where mapping indicates an anesthesia service is integral to a procedure, bundling rules apply per this policy and applicable CCI edits.

Billing Rule

Use modifier 59/ XE/ XU to indicate distinct service

Report actual anesthesia time in one-minute increments; do not add time for pre- or post-placement of blocks when those blocks are placed before induction or after emergence. Duplicate anesthesia code submissions are reimbursed only once (except as noted for distinct operative sessions or MD/CRNA split payment). When billing, use modifier 59 or XE/XP/XS/XU to indicate a distinct procedural or pain management service when appropriate. Percent of charge adjustments apply for QY/QK/QX modifiers per the Required Anesthesia Modifiers table.

Use modifier 59 or XE/XE/XU to indicate distinct procedural service when allowed (see Procedural or Pain Management Bundled Codes Allowed with Modifiers group).
Report actual anesthesia time in one-minute increments (e.g., 60 minutes for one hour).
Do not add time for placement of post-surgical pain blocks if placed before induction or after emergence.
Duplicate code submissions for the same anesthesia code on the same date of service will be reimbursed only once; exceptions: additional anesthesia administration during a different operative session on same date appended with modifier 59,76,77,78,79 or XE.
Percent of charge adjustments: apply the Modifier Percentage for QK/QY/QX as shown in the Required Anesthesia Modifiers table (e.g., QK/QY/QX reported result in 50% payment adjustments where specified).
When surgeon performs anesthesia, modifier 47 applies and anesthesia may be considered bundled into the surgical service unless otherwise indicated.

Policy provides three explicit examples.

Billing Rule

Obstetric add-on coding

When reporting neuraxial labor analgesia (01967) with obstetric add-ons, report the primary 01967 time separately (subject to the 435-minute cap) and report add-on times for 01968 and 01969 separately. UnitedHealthcare will consider add-on codes 01968 and 01969 for reimbursement when billed with primary CPT 01967 by the same or different individual provider for the same member.

Key obstetric codes: 01967, 01968, 01969
01967 time capped at 435 minutes; add-on times (01968/01969) reported separately and not added to 01967 time

Place-of-service limitation: 19, 21, 22, 25
01996 reimbursable once per date (excluding insertion day)
01996 is included in pain management procedure if submitted on same date by the Same Individual Physician or Other QHP

Modifiers that allow no additional reimbursement above usual fee

The following modifiers do not allow additional reimbursement above the usual fee when reported; include on claims where applicable to identify altered circumstances but expect no extra payment.

23 — Unusual anesthesia circumstances
47 — Anesthesia by surgeon
GC — Service delivered under supervision of a resident
G8/G9 — Monitored anesthesia care indicators
QS — Monitored anesthesia care by CRNA