Health New England Updates Anesthesia Guidelines

December 2017~

Healthcare New England (HNE) has issued updated anesthesia guidelines surrounding the use CPT® codes and claim submissions.

For all plans (Commercial Self-Funded, Commercial Fully Funded, Medicare Advantage, and Be Healthy), HNE follows the AMA CPT® Manual guidelines: “All anesthesia services are reported by use of the anesthesia five-digit procedure code (0100-01999) plus the addition of a physical status modifier. The use of other optional modifiers may be appropriate.” Medical direction modifiers are reported in the first position after the anesthesia code and additional modifiers are reported in the second position.

For Commercial and Self-Funded Plans all participating providers (including Oral Surgeons) must bill anesthesia claims using:

  • Codes from the Anesthesia section of the CPT® Coding Guide
  • Anesthesia modifiers and minutes information.
  • The appropriate modifier in the first modifier position for services performed directly by a physician.

When submitting claims:

  • Anesthesia services billed electronically should include a qualifier of “MJ” (minutes) in the SV1 segment, element SV103 (Unit or basis for Measurement Code). This means that the anesthesia minutes would be mapped to the minute field and not the count / unit.
  • Claims submitted on paper should also include the actual time parameter “start time and end time” as well as the total number of minutes in Field 24G of the CMS-1500 claim form. Payment is calculated using the total number of minutes submitted.
  • The count field should = 1 and minutes should always be in the minute field.
  • Reporting of physical status modifiers can be billed in 2nd or subsequent modifier fields.

Providers are responsible for submission of accurate claims. All Electronic Data Interchange (EDI) claims must be submitted in accordance with HIPAA 5010 Standards and Paper claims must be submitted on either CMS1500 or CMS1450 (UB04) claim forms. HNE’s reimbursement policy includes the use of Current Procedural Terminology (CPT®1), guidelines from the Centers for Medicare and Medicaid Services (CMS), and other coding guidelines. Providers will be reimbursed based on the codes(s) that correctly describe the health care services provided.

For full details on the requirements for each plan, refer to HNE’s Anesthesia payment policy update.

CPT® is a registered trademark of the American Medical Association.



Source(s): Health New England Payment Policy Update; Health New England Provider Resources;