CurrentWPS Health InsurancePolicy 1011

Anesthesia Reimbursement Policy

Defines billing and payment rules for anesthesia services (CPT 00100-01999) for all commercial lines of business, applicable to UB-04 and CMS-1500 claims, including time reporting, base units, modifier adjustment rates, qualifying circumstances, and documentation expectations.

Policy Summary

PayerWPS Health Insurance

PolicyAnesthesia Reimbursement Policy

Policy CodePolicy 1011

Change TypeReviewed (no material changes)

Effective DateFeb 1, 2020

Next Review DateDec 1, 2026

Key ActionReport anesthesia time in one-minute increments; divide total minutes by 15 and round up to the nearest tenth when calculating time units for reimbursement.

SourceLink

POLICY UPDATE CHANGES

Policy reviewed on multiple dates including 12/15/2025; no specific clinical policy statement changes indicated.

1011Policy Number

00100-01999Primary CPT Range Covered

AA,AD,QK,QS,QX,QY,QZ,P1-P6Modifiers Specified

Policy Summary

This policy documents payment and coding expectations for anesthesia services across commercial lines of business, aligning with AMA CPT, ASA base units, and CMS anesthesia billing rules. It defines that anesthesia services are reported using CPT anesthesia codes 00100-01999, requires anesthesia time to be reported in minutes (with total minutes divided by 15 and rounded up to the nearest tenth), and specifies that base units apply only to the primary (most complex) procedure. The policy applies to claims submitted on both UB-04 and CMS-1500 forms (or electronic equivalents) for network and non-network providers and emphasizes provider responsibility for accurate, complete, and legible documentation to support billed services.

General Anesthesia Reimbursement Rules

Payment and reporting requirements for anesthesia services:

Report CPT range: Anesthesia services should be reported using CPT anesthesia codes 00100-01999.
Source aligns with AMA/CPT and policy primary CPT range.
Anesthesia time definition: Anesthesia time begins when the anesthesiologist or qualified healthcare professional begins to prepare the patient for anesthesia care in the operating room (or equivalent area) and ends when the anesthesiologist or qualified healthcare professional is no longer in personal attendance.
Definition per AMA/CPT in policy.
Time reporting and conversion: Time spent performing anesthesia services is reported in one-minute increments; total minutes reported are divided by 15 and rounded up to the nearest tenth.Time reported in minutes; total minutes divided by 15 and rounded up to nearest tenth
Base units application: Allowable base units are consistent with ASA; base units are used only for the primary (most complex) procedure and not for secondary procedures.
Physician performing surgical service exclusion: With limited exceptions and consistent with CMS rules, no separate payment is allowed for anesthesia services performed by the physician who also furnishes the medical or surgical service (including local/regional anesthesia and most nerve blocks).
Multiple procedures rule: Multiple surgical procedures follow ASA billing guidelines; report only the anesthesia code for the most complex service.
Coding standards: Anesthesia services must be coded appropriately per AMA/CPT, CPT Assistant, HCPCS, DRG guidelines, CMS NCCI Policy Manual and other CMS guidelines.
Documentation responsibility: Providers are responsible for accurate, complete, legible documentation of services performed.

Qualifying Circumstances

Circumstances that affect reimbursement:

Qualifying Circumstances: Qualifying circumstances for anesthesia codes as identified in the AMA CPT manual will follow the Status B reimbursement policy.

Follows AMA CPT Status B reimbursement policy.

Modifiers, Adjustment Rates & Billing Actions

Modifier Adjustment Rates

Payment adjustment percentages by anesthesia billing modifiers:

AA: Anesthesia services performed personally by anesthesiologist; Adjustment Rate = 100% of Fee Schedule/Contracted Rate.100% of Fee Schedule/Contracted Rate

AD: Medical supervision by a physician; more than four concurrent anesthesia procedures; Adjustment Rate = 50% of Fee Schedule/Contracted Rate.50% of Fee Schedule/Contracted Rate

QK: Medical direction of 2, 3, or 4 concurrent anesthesia procedures involving qualified individuals; Adjustment Rate = 50% of Fee Schedule/Contracted Rate.50% of Fee Schedule/Contracted Rate

QS: Monitored anesthesiology care service; Adjustment Rate = 100% of Fee Schedule/Contracted Rate.100% of Fee Schedule/Contracted Rate

QX: CRNA service with medical direction by a physician; Adjustment Rate = 50% of Fee Schedule/Contracted Rate.50% of Fee Schedule/Contracted Rate

QY: Medical direction of one CRNA by an anesthesiologist; Adjustment Rate = 50% of Fee Schedule/Contracted Rate.50% of Fee Schedule/Contracted Rate

QZ: CRNA service without medical direction by a physician; Adjustment Rate = 100% of Fee Schedule/Contracted Rate.100% of Fee Schedule/Contracted Rate

P1-P6 Physical Status Modifiers: P1: no additional units; P2: no additional units; P3: one additional unit; P4: two additional units; P5: three additional units; P6: no additional units.P1: none; P2: none; P3: 1 unit; P4: 2 units; P5: 3 units; P6: none

Billing Rule

Modifier usage and adjustment rates

Apply the appropriate anesthesia and physical status modifiers on claims to reflect the provider's role and to trigger the specified adjustment rates.

Billing Rule

Report anesthesia time in minutes and convert to units

Report anesthesia time in one-minute increments. Convert total minutes to time units by dividing the total minutes by 15 and rounding up to the nearest tenth before submitting for reimbursement.

Time reported in minutes; total minutes divided by 15 and rounded up to nearest tenth

Billing Rule

Bill only primary anesthesia procedure

When multiple surgical procedures occur, report only the anesthesia procedure code for the most complex (primary) service; base units apply only to that primary procedure and not to secondary procedures.

Documentation Required

Maintain complete documentation

Maintain accurate, complete, and legible documentation of anesthesia services performed to support billed codes in accordance with AMA/CPT and CMS guidelines.

Code Lists

Anesthesia CPT Codes (primary billed range)CPT

00100-01999

Anesthesia services codes; general anesthesia surgical services should be billed in this range.

Anesthesia Modifiers with Adjustment RatesModifier

AA	Anesthesia services performed personally by anesthesiologist; 100% of Fee Schedule/Contracted Rate.
AD	Medical supervision by a physician; more than four concurrent anesthesia procedures; 50% of Fee Schedule/Contracted Rate.
QK	Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals; 50% of Fee Schedule/Contracted Rate.
QS	Monitored anesthesiology care service; 100% of Fee Schedule/Contracted Rate.
QX	CRNA service with medical direction by a physician; 50% of Fee Schedule/Contracted Rate.
QY	Medical direction of one CRNA by an anesthesiologist; 50% of Fee Schedule/Contracted Rate.
QZ	CRNA service without medical direction by a physician; 100% of Fee Schedule/Contracted Rate.
P1	Physical status modifier P1; A normal healthy patient; no additional units.
P2	Physical status modifier P2; A patient with mild systemic disease; no additional units.
P3	Physical status modifier P3; A patient with severe systemic disease; one additional unit.

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Definitions

Anesthesia timeBegins when the anesthesiologist or qualified healthcare professional begins to prepare the patient for anesthesia care in the operating room (or equivalent area) and ends when the clinician is no longer in personal attendance.

Base unitsAllowable base units for anesthesia codes are consistent with ASA and are used only for the primary (most complex) procedure, not for secondary procedures.

Consistent with AMA/CPT, ASA, and CMS guidance, this policy emphasizes adherence to coding and documentation guidelines—including use of industry standard modifiers and ASA billing rules for multiple procedures—and outlines modifier adjustment rates (for example, AA = 100% and QK/AD/QX/QY = 50% of Fee Schedule/Contracted Rate where applicable) to ensure correct reimbursement.

Policy Revision Timeline

06/23/2021review

Policy reviewed on multiple dates including 12/15/2025; no specific clinical policy statement changes indicated.

07/25/2022review

Policy reviewed on multiple dates including 12/15/2025; no specific clinical policy statement changes indicated.

06/26/2023review

Policy reviewed on multiple dates including 12/15/2025; no specific clinical policy statement changes indicated.

12/23/2024review

Policy reviewed on multiple dates including 12/15/2025; no specific clinical policy statement changes indicated.

12/15/2025reviewLatest

Policy reviewed on multiple dates including 12/15/2025; no specific clinical policy statement changes indicated.