Anesthesia Guidelines

Anesthesia services provided in the operating suite include, but are not limited to:

• Preanesthesia visits, services in the preoperative area and post-anesthesia visits 
• All preoperative visits, postoperative visits and/or monitoring  
• Constant physical attendance while surgery is being performed and monitoring the patient’s vital signs throughout surgery    
• Administration of fluids or blood incident to the anesthesia or surgery, the administration of drugs which change the state of sensation or consciousness or, in very limited circumstances, withholding such drugs deliberately where it is in the best interest of the patient 
• Following the patient through recovery from the effects of drugs (those administered before, during and immediately after the surgery) 

Anesthesia Time 

Anesthesia time begins with the initial administration of anesthetic agents by the anesthesiologist and ends when the patient is released to the recovery area. 

The total anesthesia allowed amount is an accumulation of base units plus time units. Base units will be internally assigned by Blue Cross and Blue Shield of Nebraska (BCBSNE) using the American Society of Anesthesiologists (ASA) Relative Value Guide based on the CPT anesthesia procedure code submitted. Every 15 minutes is considered one time unit. LIST ONLY THE TOTAL NUMBER OF MINUTES IN THE UNITS FIELD. DO NOT LIST CALCULATED TIME UNITS OR START/STOP TIMES ON THE CLAIM.  

The base units + time units are calculated by BCBSNE’s claims processing system. Reporting time units in the unit field can result in underpayment.  

Exception: OB anesthesia codes are priced at a flat fee. 

Personally Performed, Medically Directed and Medically Supervised

An anesthesia modifier is required to indicate whether a procedure was personally performed, medically directed or medically supervised. Anesthesia modifiers should only be reported with CPT anesthesia codes 00100-01999. Effective Jan. 1, 2022, BCBSNE will adjust the allowed amount by the modifier percentage, as shown below.

Physical Status  

Physical status modifiers are not required. There is no additional reimbursement for modifiers. 

Qualifying Circumstances

Qualifying circumstance codes are used to report difficult circumstances. These codes are considered content of service, and there is no additional reimbursement for these codes.

Duplicate Anesthesia Services

When duplicate anesthesia codes are reported by the same or different physician or other qualified health care professional for the same patient on the same date of service, only the first submission of that code will be reimbursed. However, an MD and a CRNA can render anesthesia administration services simultaneously during the same operative session, each receiving 50% of the allowed amount, by reporting modifiers QK or QY and QX. 

Anesthesia Standby 

Non-active participation by an anesthesiologist or CRNA who is physically present during a surgical procedure is not a covered service. Charges for anesthesia standby will be denied as not covered. 

Moderate Sedation (Conscious Sedation) 

Moderate sedation services are reimbursed when provided by the same or different physician or other qualified health care professional performing the diagnostic or therapeutic procedure. 

Intravenous Analgesia  

Intravenous Analgesia is defined as the administration of analgesic, narcotic, neuroleptic, hypnotic or amnesic agents for rendering a patient insensible to pain during surgical, obstetrical and certain other medically necessary procedures. 

Benefits for the administration of intravenous analgesia is content to the administration of anesthesia.  

Local Infiltration, Digital Block Anesthesia, Regional Block Anesthesia (Spinal, Saddle, Caudal Blocks)

When administered by the surgeon or assistant surgeon, charges for these procedures are considered to be content of service. 

If the nerve block is the mode by which anesthesia and pain control are administered, it is considered part of the anesthesia, and the anesthesia code should be billed.       

Time units do not apply to certain codes. The allowance is a flat fee. Please follow appropriate billing guidelines.