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Anesthesia Billing Guide
- Anesthesia Billing Codes
- Anesthesia Billing Modifiers
- Anesthesia
- Concurrent, Medical Direction and Supervision
- Daily Management and Pain Management
- Group/Member Practice Responsibilities
- Local Coverage Determinations
- Moderate (Conscious) Sedation
- Monitoring Anesthesia Services
- National Coverage Determinations
- Payment and Reimbursement
- Provider Qualifications
- Teaching Anesthesiology Services
- Resources and References
- Related Articles
Anesthesia
General Anesthesia Information
Anesthesia is the administration of a drug or gas to induce partial or complete loss of consciousness. Services involving administration of anesthesia should be reported by the use of the CPT anesthesia five-digit procedure code plus modifier code(s).
Surgery codes are not appropriate unless the anesthesiologist or qualified nonphysician anesthetist is performing the surgical procedure.
Performed with Anesthesia by an Anesthesiologist and Anesthesia and Medical/Surgical Services Provided by Same Physician.
The following may provide anesthesia services:
- Physician anesthesiologist
- Certified Registered Nurse Anesthetist (CRNA) and may provide anesthesia services under the medical supervision of a physician
- Anesthesiologist Assistant (AA) may provide anesthesia services under the medical supervision of a physician
The continuum of complexity in anesthesia services (from least intense to most intense) ranges from:
- Local or topical anesthesia
- Moderate (conscious) sedation
- Regional anesthesia
- General anesthesia
Local or topical anesthesia involves numbing a specific part of the body to prevent any feeling of pain during surgical procedures. An anesthetic drug - which has numbing effects - is applied to a certain part of the patient's body.
Moderate sedation is a drug induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. It does not include minimal sedation, deep sedation or monitored anesthesia care.
Moderate sedation, or conscious sedation, is medicine used during procedures to help a patient feel relaxed and calm. Patient will be awake and able to follow directions without anxiety or pain. Patient(s) may remember little to none of the procedure.
Regional anesthesia is medication injected near a cluster of nerves to numb only the area of body that requires surgery. Patients may remain awake or may be given a sedative.
General anesthesia is a medically induced state of unconsciousness loss of protective reflexes, resulting from the administration of one or more general anesthetic agents. General anesthesia is carried out to allow medical procedures that would otherwise be intolerably painful for the patient; or where the nature of the procedure itself precludes the patient being awake.
Anesthesia services include the usual pre-operative or post-operative visits, the anesthesia care during the procedure, the administration of fluids and/or blood and the usual monitoring services (e.g., ECG, temperature, blood pressure, oximetry, scenography and mass spectrometry).
Unusual forms of monitoring (e.g., intro-arterial, central venous and Swanz-Ganz catheters) are not included.
Noncovered Anesthesia Services
The following anesthesia services are noncovered:
- Stand by
- Anesthesia for dental services (if the dental service is noncovered, the anesthesia service is noncovered)
- Anesthesia for cosmetic surgery
- If the surgery is not covered, then the anesthesia is also not covered.
Revised 10/25/2024