[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-387321-105":59,"doc-detail-387321-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","anesthesia-policy-reimbursement-policy","Anesthesia Policy - Reimbursement Policy","","UnitedHealthcare anesthesia reimbursement policy sets requirements for submitting accurate claims using CMS-1500 (or electronic equivalents) and, when specified, UB04 forms. It explains coding basis using CPT®/HCPCS modifiers, ASA RVG/CROSSWALK, and CMS NCCI guidance, and clarifies that related references are definitional. The policy outlines anesthesia service reporting ranges, time-based reimbursement via the Standard Anesthesia Formula, and modifier-driven Allowed Amount adjustments, including requirements for anesthesia modifiers and physical status modifiers.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/anesthesia-policy-reimbursement-policy/387321/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/anesthesia-policy-reimbursement-policy/387321.png","ImageObject",300,407,{"name":92,"@type":93},"Jiven","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-26","2026-09-24",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What claim forms does this anesthesia reimbursement policy apply to?","Question",{"text":112,"@type":113},"It applies to services reported using the CMS-1500 Health Insurance Claim Form (and its electronic equivalent), and—when specified—to UB04 forms.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What CPT anesthesia code range must be used for anesthesia services?",{"text":117,"@type":113},"Anesthesia services must be submitted with a CPT anesthesia code in the range 00100-01999, excluding 01953 and 01996.",{"name":119,"@type":110,"acceptedAnswer":120},"How do anesthesia modifiers affect reimbursement?",{"text":121,"@type":113},"All anesthesia services, including Monitored Anesthesia Care, must include a required anesthesia modifier in the first modifier position; UnitedHealthcare adjusts the Allowed Amount based on the Modifier Percentage.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},387321,1790388983,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":41,"preview_page_count":4},1099513958607,"https://ap-avatar.wpscdn.com/avatar/100002390cf8733938c?x-image-process=image/resize,m_fixed,w_180,h_180&k=1778829742770036399","Anesthesia Policy, Professional  \nIMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY  \nYou are responsible for submission of accurate claims. This reimbursement policy is intended to ensure that you are reimbursed based on the code or codes that correctly describe the health care services provided. UnitedHealthcare reimbursement policies may use Current Procedural Terminology (CPT®*), Centers for Medicare and Medicaid Services (CMS) or other coding guidelines. References to CPT or other sources are for definitional purposes only and do not imply any right to reimbursement.  \nThis reimbursement policy applies to all health care services billed on CMS 1500 forms and, when specified, to those billed on UB04 forms. Coding methodology, industry-standard reimbursement logic, regulatory requirements, benefits design and other factors are considered in developing reimbursement policy.  \nThis information is intended to serve only as a general reference resource regarding UnitedHealthcare’s reimbursement policy for the services described and is not intended to address every aspect of a reimbursement situation. Accordingly, UnitedHealthcare may use reasonable discretion in interpreting and applying this policy to health care services provided ina particular case. Further, the policy does not address all issues related to reimbursement for health care services provided to UnitedHealthcare enrollees. Othe  \nr factors affecting reimbursement may supplement, modify or, in some cases, supersede this policy. These factors may include, but are not limited to: legislative mandates, the physician or other provider contracts, the enrollee’s benefit coverage documents and/or other reimbursement, medical or drug policies. Finally, this policy may not be implemented exactly the same way on the different electronic claims processing systems used by UnitedHealthcare due to programming or other constraints; however, UnitedHealthcare strives to minimize these variations.  \nUnitedHealthcare may modify this reimbursement policy at any time by publishing a new version of the policy on this Website. However, the information presented in this policy is accurate and current as of the date of publication.  \n*CPT Copyright American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.  \n\n| Table of Contents |\n| --- |\n| Application\u003Cbr>Policy\u003Cbr>Overview\u003Cbr>Reimbursement Guidelines\u003Cbr>Anesthesia Services\u003Cbr>Modifiers\u003Cbr>Reimbursement Formula\u003Cbr>Multiple or Duplicate Anesthesia Services Anesthesia and Procedural Bundled Services Daily Hospital Management\u003Cbr>Obstetric Anesthesia Services\u003Cbr>Definitions\u003Cbr>Questions and Answers\u003Cbr>Resources\u003Cbr>History |\n\n\n| Application |\n| --- |\n| This reimbursement policy applies to services reported using the 1500 Health Insurance Claim Form (a/k/a CMS-1500) or its electronic equivalent or its successor form. This policy applies to all products, all network and non-network physicians and Other Qualified Health Care Professionals (QHPs) , including, but not limited to, non-network authorized and percent of charge contract physicians and Other QHPs.\u003Cbr>UnitedHealthcare Commercial\u003Cbr>This Reimbursement Policy applies to all UnitedHealthcare Commercial benefit plans.\u003Cbr>UnitedHealthcare Individual Exchange\u003Cbr>This Reimbursement Policy applies to all Individual Exchange benefit plans. |\n\n\n| Policy |  |  |  |  |\n| --- | --- | --- | --- | --- |\n| Overview |  |  |  |  |\n| UnitedHealthcare's reimbursement policy for anesthesia services is developed in part using the American Society of Anesthesiologists (ASA) Relative Value Guide (RVG®), the ASA CROSSWALK®, and Centers for Medicare and Medicaid Services (CMS) National Correct Coding Initiative (NCCI) Policy Manual, CMS NCCI edits and the CMS National Physician Fee Schedule.\u003Cbr>Current Procedural Terminology (CPT®) codes and modifiers and Healthcare Common Procedure Coding System (HCPCS) modifiers identify services rendered. These services ","cbCaijPN6uP8ctEn","https://ap.wps.com/l/cbCaijPN6uP8ctEn","pdf",280546,12,"English","# Application\n## Policy Overview\n## Reimbursement Guidelines\n## Anesthesia Services\n## Modifiers\n## Reimbursement Formula\n## Multiple or Duplicate Anesthesia Services\n## Anesthesia and Procedural Bundled Services\n## Daily Hospital Management\n## Obstetric Anesthesia Services\n# Definitions\n## Questions and Answers\n## Resources\n## History","[{\"question\":\"What claim forms does this anesthesia reimbursement policy apply to?\",\"answer\":\"It applies to services reported using the CMS-1500 Health Insurance Claim Form (and its electronic equivalent), and—when specified—to UB04 forms.\"},{\"question\":\"What CPT anesthesia code range must be used for anesthesia services?\",\"answer\":\"Anesthesia services must be submitted with a CPT anesthesia code in the range 00100-01999, excluding 01953 and 01996.\"},{\"question\":\"How do anesthesia modifiers affect reimbursement?\",\"answer\":\"All anesthesia services, including Monitored Anesthesia Care, must include a required anesthesia modifier in the first modifier position; UnitedHealthcare adjusts the Allowed Amount based on the Modifier Percentage.\"}]","Anesthesia Policy - Reimbursement Policy | PDF",1790285013]