Anesthesia Billing form Guidelines

Prior Authorization

Anesthesia itself does not require prior authorization; however, prior authorization may be required for the related surgical procedure or service.

Time-Based Units

During the first 4 hours of service, 15 minutes equals 1 unit. If services are provided for longer
than 4 hours in one occurrence, each 10-minute period after the initial 4 hours equals 1 unit. A
period less than a unit should be rounded up to the next unit.

Example A: 5 hours or 300 minutes equals 22 units – 16 units for the first 4 hours (1 unit per
each 15 minutes) and 6 units for the last hour (1 unit per each 10 minutes).

Example B: 128 minutes is billed as 9 units (8 units for the first 120 minutes and 1 additional unit for the remaining 8 minutes).

Completing the Claim Form

· Field 19: When billing a time-based code,enter the total minutes of reportable anesthesia time in Field 19.

· Field 24D: On the bottom, white half of the claim line, enter one CPT code and one physical status modifier
(P1-P6). List additional modifiers when appropriate

· Field 24G:
o When using a time-based code, enter the number of reportable anesthesia time units; do not add base units or modifier units to the time units.
o When using an occurrence-based code, enter a “1” for each occurrence. The following codes are paid per occurrence: 01953, 01967, 01968, 01969, 01996, 99100, 99116, 99135 and 99140.

CPT Code 99140
Medicaid carefully monitors for the appropriate use of code 99140 and modifiers P3, P4 and P5. Providers’ in-office records must verify medical necessity of this procedure.

Code 99140 should be used only for emergency conditions. This does not include a normal delivery or use of an epidural during delivery.

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