CurrentWPS Health InsurancePolicy 1011

Anesthesia Services

Defines WPS Health Insurance reimbursement rules for anesthesia services billed on UB-04 and CMS-1500 forms for commercial lines of business, applicable to network and non-network physicians and qualified healthcare professionals.

Policy Summary

PayerWPS Health Insurance

PolicyAnesthesia Services

Policy CodePolicy 1011

Change TypeNo material changes

Effective DateFeb 1, 2020

Next Review DateDec 1, 2025

Key ActionProviders must accurately document services and submit claims using valid industry-standard codes and modifiers when submitting anesthesia claims on UB-04 or CMS-1500.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

00100-01999CPT anesthesia code range

minutesTime reporting

50%/100%Modifier adjustment rates

P1-P6Physical status modifiers

Commercial LOBApplies to

Anesthesia Reimbursement Criteria

Anesthesia reimbursement criteria

Covered when ALL of the following are met:

Billing and coding must follow AMA CPT, ASA, and CMS anesthesia rules as described in this policy.

Anesthesia services for general surgical care are billed using CPT codes in the range 00100-01999.00100-01999

Anesthesia time is recorded in one-minute increments; total minutes reported are divided by 15 and rounded up to the nearest tenth for unit calculation.

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 clinician is no longer in personal attendance.

Policy Summary

PayerWPS Health Insurance

PolicyAnesthesia Services

Policy CodePolicy 1011

Change TypeNo material changes

Effective DateFeb 1, 2020

Next Review DateDec 1, 2025

Key ActionProviders must accurately document services and submit claims using valid industry-standard codes and modifiers when submitting anesthesia claims on UB-04 or CMS-1500.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Anesthesia Codes, Modifiers, and Time Reporting

Covered Anesthesia CPT CodesCPTCovered

00100-01999

General anesthesia surgical services — report appropriate CPT anesthesia code range; time reported in minutes

Time Reporting and Operational Notes

Time reporting granularityReport anesthesia time in one-minute increments. Total minutes divided by 15 and rounded up to the nearest tenth.

Anesthesia base unitsBase units follow ASA guidelines; base units apply only to the primary (most complex) procedure and not to secondary procedures.

Multiple proceduresWhen multiple surgical procedures occur, report only the anesthesia code for the most complex service per ASA industry-standard billing guidelines.

Separate payment ruleGenerally no separate payment for anesthesia services when the physician also furnishes the medical or surgical service (e.g., local/regional blocks), consistent with CMS rules.

Anesthesia ModifiersModifier

AA	Anesthesia services performed personally by the anesthesiologist — Adjustment 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.
QK	Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals — Adjustment Rate: 50% of Fee Schedule/Contracted Rate.
QS	Monitored anesthesia care service — Adjustment Rate: 100% of Fee Schedule/Contracted Rate.
QX	CRNA service; with medical direction by a physician — Adjustment Rate: 50% of Fee Schedule/Contracted Rate.
QY	Medical direction of one CRNA by an anesthesiologist — Adjustment Rate: 50% of Fee Schedule/Contracted Rate.
QZ	CRNA service; without medical direction by a physician — Adjustment Rate: 100% of Fee Schedule/Contracted Rate.

Physical Status ModifiersModifier

P1	Normal healthy patient — No additional units.
P2	Patient with mild systemic disease — No additional units.
P3	Patient with severe systemic disease — One additional unit.
P4	Patient with severe systemic disease that is a constant threat to life — Two additional units.
P5	Moribund patient not expected to survive without operation — Three additional units.
P6	Declared brain-dead patient whose organs are being removed for donor purposes — No additional units.

Documentation and Billing Expectations

Documentation Required

Documentation and billing requirements for anesthesia claims

Providers must accurately, completely, and legibly document anesthesia services and submit claims using valid industry-standard codes and modifiers on the UB-04 or CMS-1500. Claims should be coded according to AMA/CPT and HCPCS guidelines and follow CMS coding conventions and payer modifier rules; when contract language conflicts with this policy, the Provider Program will prevail.

Document services performed in the medical record with sufficient detail to support billed CPT codes and reported anesthesia time.
Submit claims using valid industry-standard codes and modifiers (AMA/CPT, CPT Assistant, HCPCS) and follow CMS coding guidance and NCCI edits as applicable.
Use UB-04 or CMS-1500 (or electronic equivalent) for claim submission as applicable to the service and line of business.

Key Definitions and Modifier Rules

Definition of anesthesia time

Start of anesthesia timeBegins when the anesthesiologist or qualified healthcare professional begins to prepare the patient for anesthesia care in the operating room or equivalent area.

End of anesthesia timeEnds when the anesthesiologist or qualified healthcare professional is no longer in personal attendance and the patient may be safely placed under postoperative supervision.

MeasurementAnesthesia time should be reported in minutes and converted per policy (minutes divided by 15, rounded up to nearest tenth).

AA modifier

Modifier AA descriptionAnesthesia services performed personally by anesthesiologist.

Adjustment rateReimbursed at 100% of Fee Schedule Allowance/Contracted Rate.

Billing noteUse AA when the anesthesiologist personally performs the anesthesia service (per reimbursement guidelines).

AD modifier

Modifier AD descriptionMedical supervision by a physician for more than four concurrent anesthesia procedures.

Adjustment rateReimbursed at 50% of Fee Schedule Allowance/Contracted Rate.

Use caseApply AD when a physician provides medical supervision for >4 concurrent anesthesia procedures (per reimbursement guidelines).