Billing and Reimbursement Guideline: Anesthesia Billing Guideline-General Anesthesia
Guideline Publication Date:
August 4, 2011
Key coding, documentation and reimbursement points include:

Charges should be billed on a CMS-1500.

Valid anesthesia coding is required for the date and nature of service.

Any billed anesthesia code must crosswalk with the surgical procedure
performed.

Supportive diagnosis coding is also required on the claim for the procedure
performed.

Services billed by anesthesia assistants and C.R.N. A.’s will not be reimbursed.

Anesthesia start and stop times are required. Anesthesia start time is defined as
the time the anesthesiologist begins the preparation of the patient. Anesthesia end
time is defined as the time when the patient is placed under post-operative care.

Anesthesia claims are paid based on the actual anesthesia time and the anesthesia
relative value from the current year American Society of Anesthesiologists (ASA)
guide. Anesthesia time intervals are 15 minutes per unit.

Modifiers must be billed with anesthesia procedure codes to indicate whether the
procedure was personally performed, medically directed or medically supervised.
Covered Required
Modifiers Include:
AA
AD
G8
G9
Version History
Original Publication Date:
Revision Date (s):
9/1/2013
Anesthesia services personally performed by
anesthesiologist
Medical supervision by a physician, more than four
procedures
Monitored anesthesia care
Monitored anesthesia care
8/4/2011
Format change only
Neighborhood Health Plan of Rhode Island
Billing and Reimbursement Guidelines
Page 1
QS
Non Covered
Required Modifiers
Include:
QK
QX
QY
QZ
Monitored anesthesia care
Medical direction of two, three or four concurrent
anesthesia procedures
C.R.N.A service, with medical direction
Medical direction of one C.R.N.A by anesthesiologist
C.R.N.A service, without medical direction

This guideline applies to CMS-1500 claim submissions.

This guideline applies to place of service 21, 22, 23 and 24.
Please refer to Neighborhood’s provider website at http://www.nhpri.org for specific
provisions by product line.
This guideline is not a guarantee of reimbursement. Plan coverage, eligibility and
claim payment edit rules may apply.
Version History
Original Publication Date:
Revision Date (s):
9/1/2013
8/4/2011
Format change only
Neighborhood Health Plan of Rhode Island
Billing and Reimbursement Guidelines
Page 2