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) | 01112-01173 | 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 | 01610-01680 | 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, 62320-62327, 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.