Covered anesthesia services are identified by the CPT procedure codes listed in the following table. Not all services identified by CPT codes are covered (e.g., fertility-related services are not covered). Other CPT codes have limitations. These codes are updated on a quarterly basis. Providers are required to use the most current service-specific maximum allowable fee schedule in conjunction with the most current CPT reference to determine coverage of services.
Service |
Procedure Codes |
Modifier Required? |
|---|---|---|
Head |
00100-00222 |
Yes |
Neck |
00300-00352 |
Yes |
Thorax (Chest Wall and Shoulder Girdle) |
00400-00474 |
Yes |
Intrathoracic |
00500-00580 |
Yes |
Spine and Spinal Cord |
00600-00670 |
Yes |
Upper Abdomen |
00700-00797 |
Yes |
Lower Abdomen |
00800-00882 |
Yes |
Perineum |
00902-00952 |
Yes |
Pelvis (except Hip) |
01112-01190 |
Yes |
Upper Leg (except Knee) |
01200-01274 |
Yes |
Knee and Popliteal Area |
01320-01444 |
Yes |
Lower Leg (below Knee, includes Ankle and Foot) |
01462-01522 |
Yes |
Shoulder and Axilla |
01610-01682 |
Yes |
Upper Arm and Elbow |
01710-01782 |
Yes |
Forearm, Wrist, and Hand |
01810-01860 |
Yes |
Radiological Procedures |
01905-01933 |
Yes |
Burn Excisions or Debridement |
01951-01953 |
Yes |
Obstetric |
01958-01969 |
Yes |
Other Procedures |
01990-01999 |
Yes |
Vascular Injection Procedures (when Anesthesia Is Not Provided) |
36000-36248, 36568-36569, 36580, 36584, 36600-36660 |
No* |
Invasive Monitoring |
36555-36556, 36620, 93503 |
No* |
Catheter/Injections/Nerve Blocks |
62256, 62280-62281, 62310-62319, 64400-64530 |
No* |
Qualifying Circumstances for Anesthesia |
99100-99140 |
Yes (modifier "AA" only) |
*Use of modifiers for these procedure codes will result in denied claims.