ModifiedUnitedHealthcarePolicy 2026R9008A

Anesthesia Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new

UnitedHealthcare Medicare Advantage reimbursement policy governing anesthesia services billed on CMS 1500 forms (CPT 00100-01999 excluding 01953 and 01996), including time reporting, modifiers, formulas, qualifying circumstances, bundling rules, duplicate services, and select Q&A operational guidance.

Policy Summary

PayerUnitedHealthcare

PolicyAnesthesia Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new

Policy CodePolicy 2026R9008A

Change TypePolicy version change

Effective Date

Next Review DateFeb 1, 2027

Key ActionSubmit all anesthesia services with the required anesthesia modifier in the first modifier position to determine reimbursement percentage.

SourceLink

POLICY UPDATE CHANGES

Policy version change dated 2/1/2026.

Policy version change dated 2/1/2025.

Policy version change dated 2/1/2024.

00100-01999Anesthesia CPT range addressed

4Qualifying circumstance codes listed

6Key modifiers described

Policy overview

UnitedHealthcare Medicare Advantage bases anesthesia reimbursement on the ASA Relative Value Guide (ASA RVG), the ASA CROSSWALK, and CMS methodology and applies to services billed on the CMS 1500 form or its electronic equivalent. Anesthesia services must be submitted with a CPT anesthesia code in the range 00100-01999 (with 01953 and 01996 specifically excluded from being treated as time‑based anesthesia codes) and with an anesthesia modifier in the first modifier position to determine the allowed percentage. Time‑based services are reimbursed using the Standard Anesthesia Formula (without AD: ([Base Unit Value + Time Units + Modifying Units] x Conversion Factor) x Modifier Percentage; with AD: ([Base Unit Value of 3 + 1 additional unit if physician present during induction] x Conversion Factor) x Modifier Percentage) and actual Anesthesia Time must be reported in one‑minute increments. UnitedHealthcare follows CMS/NCCI bundling and modifier guidance: qualifying circumstance codes (99100, 99116, 99135, 99140) do not add base units; procedural/pain services integral to anesthesia are generally not separately reimbursable when performed by the same individual (use modifier 47 to the surgical code when surgeon performs the anesthesia); duplicate anesthesia code submissions are reimbursed only once except for permitted separate sessions or simultaneous MD/CRNA reporting with required modifiers.

Coverage criteria and definitions of anesthesia service

Anesthesia Service Definition and Reporting

Anesthesia services are reimbursed as time-based services when billed with appropriate CPT anesthesia codes and modifiers. Coverage and reimbursement follow CMS/ASA guidelines.

Anesthesia CPT code range: Submitted with a CPT anesthesia code in the range 00100-01999
Excludes codes 01953 and 01996 when referring to anesthesia services
Anesthesia time reporting: Reported with actual Anesthesia Time in one-minute incrementsAnesthesia Time reporting increment = 1 minute increments
Time begins when preparing patient for induction and ends when no longer in personal attendance
Required anesthesia modifier
- Modifier options and percentages
  - AA - Anesthesiologist MD Personally Performed100%
    Reimbursement Percentage = 100%
  - AD - Anesthesiologist MD Supervising over 4100%
    Reimbursement Percentage = 100%
  - QK - Anesthesiologist MD Supervising 2-450%
    Reimbursement Percentage = 50%
  - QY - CRNA or AA Directed by Anesthesiologist MD (Supervising 1)50%
    Reimbursement Percentage = 50%
Standard Anesthesia Formula
- Without AD: ([Base Unit Value + Time Units + Modifying Units] x Conversion Factor) x Modifier Percentage
  Standard Anesthesia Formula without Modifier AD
- With AD: ([Base Unit Value of 3 + 1 Additional Unit if anesthesia notes indicate the physician was present during induction] x Conversion Factor) x Modifier Percentage
  Standard Anesthesia Formula with Modifier AD; documentation must indicate physician presence during induction

Qualifying Circumstances

Qualifying circumstance codes identify conditions that significantly affect the anesthetic service but do not add base units per CMS guidelines.

Qualifying Circumstances: Qualifying circumstances codes: 99100, 99116, 99135, 99140

No additional base units allowed

Code lists and modifier guidance

Anesthesia CPT codes considered anesthesia servicesCPTCovered

00100-01999

Anesthesia services time-based; excludes 01953 and 01996 when referring to anesthesia services

Excluded from anesthesia service designationCPT

01953	Add-on code (not considered anesthesia service for time-based reporting per policy)
01996	Daily hospital management of epidural or subarachnoid drug administration; treated specially in policy

Qualifying circumstance codes (no additional base units)CPT

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

Anesthesia add-on code groupCPTCovered

01952	Primary code for which 01953 add-on applies
01953	Add-on — used with 01952
01967	Primary code for which 01968/01969 add-ons apply
01968	Add-on — used with 01967
01969	Add-on — used with 01967

Modifiers affecting reimbursement percentageModifier

AA	Anesthesiologist MD Personally Performed — 100% allowed
AD	Anesthesiologist MD Supervising over 4 — 100% allowed
QK	Anesthesiologist MD Supervising 2-4 — 50% allowed
QY	CRNA or AA Directed by Anesthesiologist MD (Supervising 1) — 50% allowed
QZ	CRNA Personally Performed — 100% allowed
QX	CRNA service modifier (used with QK/QY scenarios)
GC	HCPCS mapping for modifier 22
G8	HCPCS mapping for modifier 23
G9	HCPCS mapping for modifier 47
QS	HCPCS mapping for modifier 59

1–10 of 14

1/2

Evaluation & Management codes excluded/includedCPT

99291-99292

Critical care — not included in anesthesia; separately reimbursable

Billing, documentation, and operational rules (action items)

Billing Rule

Report anesthesia modifier in first modifier position

All anesthesia services must include the required anesthesia modifier in the first modifier position so the reimbursement percentage can be determined from the modifier.

Billing Rule

Report actual anesthesia time in minutes

Submit actual Anesthesia Time in one-minute increments on claims; do not add time for blocks placed before induction or after emergence.

Anesthesia Time reporting increment: 1 minute increments

Billing Rule

Use highest base unit anesthesia code for multiple procedures

When multiple procedures occur during a single anesthesia administration, report only the single anesthesia code with the highest Base Unit Value and report the combined total anesthesia time with that code.

Add-on codes: 01953 (with 01952); 01968/01969 (with 01967) — time reported with primary anesthesia code

Billing Rule

Duplicate code submission rule

When identical anesthesia codes are submitted for the same patient on the same date, only the first submission is reimbursed, except for separate operative sessions (appropriate appended modifier) or simultaneous MD/CRNA administration reported with the specified modifiers.

Exceptions: different operative session with modifier 59/76/77/78/79/XE/XP/XU; simultaneous MD/CRNA reported with QK or QY and QX

Documentation Required

Physician presence for AD modifier

To allow the additional unit in the AD reimbursement formula, documentation must indicate the physician was present during induction.

Billing Rule

CPT 01996 once per date of service

CPT 01996 is separately reimbursable once per date of service in CMS places of service 21, 22, or 25 (excluding the day of insertion), but is considered included in the pain management procedure if billed by the same individual on the same date.

Codes: ["01996"]

Billing Rule

Append modifier 47 when surgeon performs anesthesia

If the surgeon personally performs the anesthesia for a procedure they also perform, append modifier 47 to the surgical code and do not report anesthesia section CPT codes.

Billing Rule

Critical care E/M separate reimbursement

Critical care CPT codes 99291 and 99292 are not included in an anesthesia service and are separately reimbursable; they may be reported in addition to anesthesia when appropriate.

Codes: ["99291","99292"]

Billing Rule

CRNA reporting requirements

CRNA services should be reported with the appropriate modifier (QX or QZ) and must be submitted under the supervising physician's name or employer/entity name unless the CRNA is individually credentialed/contracted by UnitedHealthcare Medicare Advantage.

Report with modifiers: QX, QZ

Key definitions

Definitions

Allowable AmountDollar amount eligible for reimbursement to the physician or other qualified health care professional on the claim.

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

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

Base ValueUnits (Base Unit Value) assigned per anesthesia code by ASA representing usual anesthesia services excluding time and modifying units.

Standard Anesthesia FormulaFormula used to calculate reimbursement with/without AD modifier as described in policy.

Same Individual Physician or Other Qualified Health Care ProfessionalSame individual rendering services reporting same NPI.

Same Specialty Physician or Other Qualified Health Care ProfessionalPhysicians/qualified professionals of same group and same specialty reporting same Federal Tax ID.

OpenPayer

Anesthesia Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new

Policy overview

Coverage criteria and definitions of anesthesia service

Code lists and modifier guidance

Billing, documentation, and operational rules (action items)

Key definitions

Frequently asked operational questions

Policy revision timeline