UHC Revises Anesthesia Payment Policy

Before the end of the year, the way in which UnitedHealthcare contracted physicians and their supporting staff should report both general and obstetrical anesthesia services will change.

News of recent Anesthesia Payment Policy revisions was published in UnitedHealthcare’s May 2009 Network Bulletin:

Anesthesia and Pain Management CANPC

Currently, UnitedHealthcare’s Anesthesia Payment Policy allows physicians to report CPT® anesthesia codes (00100 – 01999) or select surgery/medicine codes (CPT® Category I codes 10021- 69990, 90281- 99199) and select Category III codes when submitting claims for general anesthesia or monitored anesthesia care services.

On Dec. 1, UnitedHealthcare will revise this policy to require use of 00100 – 01999 (excluding 01953 and 01996) to report general anesthesia or monitored anesthesia care services rendered. Claims for general anesthesia or monitored anesthesia care submitted with any surgery/medicine codes (Category I codes 10021- 69990, 90281- 99199) or any Category III codes and submitted with anesthesia modifiers and/or with anesthesia time in minutes will not be eligible for payment.

When reporting the provision of the covered medical or surgical procedure, physicians should submit the claim using the appropriate surgery/medicine codes (Category I codes 10021-99499) and Category III. These services should be submitted without anesthesia modifiers and/or without anesthesia time in minutes.

Obstetrical Anesthesia Services

Under the current UnitedHealthcare Anesthesia Reimbursement Policy, when different individual physicians or health care professionals provide the epidural anesthesia for a vaginal delivery and a cesarean section delivery with or without a hysterectomy, the services are reported as follows:

  • When one physician provides an epidural for a planned vaginal delivery and another physician performs the cesarean section delivery, then report CPT® codes 01967 Neuraxial labor analgesia/anesthesia for planned vaginal delivery (this includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor) and 01961 Anesthesia for cesarean delivery only, respectively.
  • When one physician provides an epidural for a planned vaginal delivery and another physician performs the cesarean section delivery followed by a hysterectomy, then report CPT® codes 01967 and 01963 Anesthesia for cesarean hysterectomy without any labor analgesia/anesthesia care, respectively.

Effective in third quarter of 2009 and based on American Society of Anesthesiologists (ASA) guidelines, UnitedHealthcare will revise its policy as follows:

  • When different individual physicians or health care professionals provide an epidural for a planned vaginal delivery resulting in a cesarean section delivery, CPT® code 01967 should be reported with the add-on CPT® code +01968 Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia (List separately in addition to code for primary procedure performed).
  • When different individual physicians or health care professionals provide an epidural for a planned vaginal delivery resulting in cesarean section delivery followed by a hysterectomy, then CPT® code 01967 should be reported with the add-on CPT® code +01969 Anesthesia for cesarean hysterectomy following neuraxial labor analgesia/anesthesia (List separately in addition to code for primary procedure performed).

Read UnitedHealthcare’s May 2009 Network Bulletin to learn of other important new, updated and revised reimbursement and medical policies that will affect all contracted health care professionals and facilities.

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One Response to “UHC Revises Anesthesia Payment Policy”

  1. Gwen Marshall says:

    Can you please send me UHC Policy and procedure on labor & delivery and how long does the patient have to enroll baby to policy?

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