The CPT codes listed below are for reporting maternity-related anesthesia services. WV Medicaid limits payment for maternity anesthesia to eight “Time Units”. (A maximum of two hours) Base units may not be billed separately.
• 01960 – Anesthesia for vaginal delivery only
• 01961 – Anesthesia for cesarean delivery only
• 01967 – Neuraxial labor analgesia/anesthesia for planned vaginal delivery (this includes any repeat subarachnoid needle placement and drug injection and/or necessary replacement of an epidural catheter during labor)
• 01968 – Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia (List separately in addition to code for primary procedure performed) (Must be used with 01967.)
• 01969 – Anesthesia for cesarean hysterectomy following neuraxial labor analgesia/anesthesia (List separately in addition to code for primary procedure performed) (Must be used with 01967.) If the Medicaid member is a recipient of a documented emergency cesarean section, the anesthesia provider may receive reimbursement for up to two additional units of anesthesia. (See Section 519.8.4 for further details on billing emergency anesthesia.)
WV Medicaid’s payment policy for labor epidural is as follows:
• Labor epidural provided by the surgeon must be billed with the appropriate delivery anesthesia code and modifier 97. Labor epidural provided by the anesthesiologist and/or CRNA must be billed with the appropriate “0” anesthesia code
• CPT surgical codes 62311 and 62319 are not to be used to bill pain management for the three stages of delivery.
• Medications for pain relief given during the time of the epidural anesthesia are not covered as a separate procedure.
• Only one provider or team will be paid for epidural services.
• Emergency anesthesia is not allowed with the provision of epidural anesthesia or vaginal deliveries.
• The labor epidural procedures covered by WV Medicaid are inclusive of labor, delivery, and postpartum care. Additional procedure codes used for pain management are not covered.
Guidelines for Maternity-Related Anesthesia
CPT codes in the Anesthesia Obstetric section are to be used by anesthesiologists and CRNAs to bill for maternity-related anesthesia services. The delivering physician should use CPT codes in the Surgery Maternity Care and Delivery section of CPT to bill for maternity-related anesthesia services. Reimbursement for these services shall be flat fee except for general anesthesia for vaginal delivery.
The following chart is an explanation of the billable modifiers used for maternity-related anesthesia, the Louisiana Medicaid billing definitions, and the provider type that may bill using the modifier.
Modifier Provider Type That May Bill Billing Definition AA Anesthesiologist Anesthesia services performed personally by the anesthesiologist
QY Anesthesiologist Medical direction* of one CRNA
QK Anesthesiologist Medical direction of two, three, or four concurrent anesthesia procedures
QX CRNA CRNA service with medical direction by an anesthesiologist
QZ CRNA CRNA service without medical direction by an anesthesiologist
47 Delivering Physician Anesthesia provided by delivering physician
52 Delivering Physician or Anesthesiologist Reduced services
QS** Anesthesiologist or CRNA Monitored Anesthesia Care Service
*Medical direction – explanation can be found after the Surgical Anesthesia section.
** The QS is a secondary modifier only, and must be paired with the appropriate anesthesia provider modifier (either the anesthesiologist or the CRNA). The -QS modifier indicates that the provider did not introduce the epidural catheter for anesthesia, but did monitor the patient after catheter placement.
Billing Add-on Codes for Maternity-Related Anesthesia:
• When an add-on code is used to fully define a maternity-related anesthesia service, the date of delivery should be the date of service for both the primary and add-on code.
• An add-on code in and of itself is not a full service and cannot be reimbursed separately to different providers.
• A group practice frequently includes anesthesiologists and/or CRNA providers. One member may provide the pre-anesthesia examination/evaluation, and another may fulfill other criteria. The medical record must indicate the services provided and must identify the provider who rendered the service. A single claim must be submitted showing one member as the performing provider for all services rendered. In other words, the billing of these services separately will not be reimbursed.
Monitoring by Anesthesiologist or CRNA
TYPE OF ANESTHESIA CPT CODE MODIFER TIME REIMBURSEMENT
C Delivery after Epidural 01961 AA and QS or QZ and QS or QX and QS Record minutes $189.77
C Delivery following epidural for planned vaginal delivery 01967 +01968 AA and QS or QX and QS Record minutes $145.80 $43.87C
Delivery following epidural for planned vaginal delivery 01967 +01968 QZ and QS or QX and QS Record minutes $145.80 $43.86