Procedure Codes and Modifiers
Anesthesia providers are required to utilize the appropriate anesthesia code
identified in the current Relative Value Guide published by the American
Society of Anesthesiologists. Time in attendance should be billed by listing
HP will calculate total units by dividing the total minutes (reported in block
24G) by 15, rounding up to the next whole number, and adding the time units
to the auto-loaded base unit values. The base unit values are derived from
the ASARVG for CPT-4 anesthesia codes.
of anesthesia time in block 24G of the CMS-1500 claim form.
Type of service “7” should be used for billing anesthesia codes (00100-
01997). The (837) Institutional electronic claim and the paper claim have
been modified to accept up to four Procedure Code Modifiers. Effective
October 1, 2004 to bill for code 90784, bill the first line item with the code and
one unit. Bill the second line item with code 90784 with modifier 76 (repeat
procedure) and 3 units.
The number of qualifying factor units is multiplied by the price allowed for
anesthesia services. For more information regarding qualifying factors, see
the next section of this manual.
Beginning June 14, 2002, qualifying factors will be reimbursable. Qualifying
factors allow for anesthesia services provided under complicated situations
depending on irregular factors (ex: abnormal risk factors, significant operative
conditions). The qualifying procedures would be reported in conjunction with
the anesthesia procedure code on a separate line item using 1 unit of service.
The qualifying procedure codes are indicated below.
Procedure Code Description Units
99100 Anesthesia for recipient with farthest ages, over
seventy and under one year 1
99116 Complication of anesthesia by utilization of total
body hypothermia 1
99135 Complication of anesthesia by utilization of
controlled hypotension 1
99140 Complication of anesthesia by emergency