Billing Multiple Anesthesia Modifiers

When two or more modifiers are necessary to identify the anesthesia services, use modifier ZG with the appropriate five-digit CPT-4 anesthesia code and explain the applicable modifiers in the Remarks field (Box 80)/Reserved for Local Use field (Box 19) of the claim or as an attachment. 

Surgical and Obstetrical Anesthesia

Operating surgeons and obstetricians providing their own regional anesthesia (for example, caudal or epidural) must bill the anesthesia on a separate claim line from the surgical services.  Bill using the five-digit CPT-4 surgery code with modifier 47.  Reimbursement for  the service will be the basic unit value for anesthesia for the procedure without the added value of the duration of the anesthesia.

    Local infiltration, uterine paracervical or pudendal block, digital block or topical anesthesia administered by the operating surgeon or obstetrician are included in the reimbursement for the surgical or obstetrical procedure itself and are not separately reimbursable.

Elective Sterilization

Anesthesiologists billing for the anesthesia time associated with an elective sterilization procedure must bill with either CPT-4 code 00851 or 00921. 

Tubal Ligations: Vaginal Delivery

A postpartum tubal ligation performed in connection with a vaginal delivery is considered a separate procedure.  The anesthesia for the tubal ligation must be billed with CPT-4 code 00851 (anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; tubal ligation/transection).

Tubal Ligations: Cesarean Delivery

Anesthesiologist time billed for a tubal ligation performed during a cesarean section should include the tubal ligation anesthesia by adding one (1) additional anesthesia time unit to the anesthesia time units for the cesarean section procedure (CPT-4 code 01961 or 01968). 


Anesthesiologists billing for the anesthesia time associated with a hysterectomy must bill with CPT-4 code 00846, 00848, 00944, 01962, 01963 or 01969.  Claims for these codes require a hysterectomy consent form. 

Procedures Billed Only for Diagnostic and Therapeutic Services

CPT-4 procedure codes 

62267 – 62273, 62280 – 62287, 62290 – 62297, 62310, 62311, 62318, 62319, 64400 – 64439 and 64444 – 64530 are used only for billing injection, drainage or aspiration procedures for diagnostic or therapeutic services.  Anesthesiologists performing these diagnostic and therapeutic services are acting as the primary surgeon and should bill these  CPT-4 codes with modifier AG.  These codes should not be billed with an anesthesia modifier.

    When it is necessary to administer anesthesia to perform a separate diagnostic and therapeutic procedure (for a very young or uncooperative patient, for example), the anesthesia should be billed using the applicable five-digit CPT-4 anesthesia code with an anesthesia modifier.

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