Anesthesia services are provided under difficult circumstances which may affect the condition of the patient, or present unusual operative conditions and / or risk factors.
Codes and Definitions
99100 Anesthesia for patient of extreme age, younger than 1 year and older than 70 (List separately in addition to code for primary anesthesia procedure)
99116 Anesthesia complicated by utilization of total body hypothermia (List separately in addition to code for primary anesthesia procedure)
99135 Anesthesia complicated by utilization of controlled hypotension (List separately in addition to code for primary anesthesia procedure)
99140 Anesthesia complicated by emergency conditions (specify) (List separately in addition to code for primary anesthesia procedure)
This code is eligible for separate reimbursement at the allowed amount. Separately in addition to code for primary anesthesia proedure. Thi code are assigned a status indicator of "B" (bundled code) on the CMS Physician Fee schedule, and are not eligible for separate reimbursement uder Medicare guidelines. As per CMS, the value for the qualifying circumstances has already been included in the RVUs for the primary anesthesia procedure codes. Payment for these services is always included in payment for other services not sprcified. There are no RVUs or payment amoount for these codes and separate payment is not made.
Coding Guidelines
CPT Assistant:
“Question: What are "qualifying circumstances for anesthesia," and when are they reported?
Answer: Codes 99100-99140 are add-on codes that include a list of important qualifying circumstances that significantly affect the character of the anesthesia service provided. These circumstances would be reported as additional procedure numbers qualifying an anesthesia procedure or service. More than one code in the section may be selected, if applicable. Codes 99100-99140 are listed in the Anesthesia guidelines in the CPT codebook.” (AMA2)
Medicare Physician Fee Schedule:
Qualifying circumstances CPT codes 99100 – 99140 are assigned a status indicator of “B” (bundled code) on the CMS Physician Fee Schedule, and are not eligible for separate reimbursement under Medicare guidelines. Per CMS, the value for these qualifying circumstances has already been included in the RVUs for the primary anesthesia procedure codes.
Reimbursement Guidelines
Commercial lines of business
Effective for claims processed on or after 2/25/2016, Moda Health does not separately reimburse for CPT codes 99100 – 99140. This is based on their status indicator of “B” (bundled code) on the CMS Physician Fee Schedule.
CPT codes 99100 – 99140 will deny to provider liability with denial codes:
EX: 2M0 Service/supply is considered bundled or incidental. Not eligible for separate payment. Always bundled into a related service.
CARC: 97 The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.
RARC: M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
99100+ (Anesthesia for patient of extreme age, under 1 year and over 70 {list separately in addition to code for primary procedure}) bundles with 00326 (Anesthesia for all procedures on the larynx and tracheas in children less that 1 year of age), 00834 (Anesthesia for hernia repair in the lower abdomen (not otherwise specified, under 1 year of age) and 00836 (Anesthesia for hernia repair in the lower abdomen not otherwise specified, infants less that 37 weeks gestational age at birth and less than 50 week gestation age at time of surgery).
Codes and Definitions
99100 Anesthesia for patient of extreme age, younger than 1 year and older than 70 (List separately in addition to code for primary anesthesia procedure)
99116 Anesthesia complicated by utilization of total body hypothermia (List separately in addition to code for primary anesthesia procedure)
99135 Anesthesia complicated by utilization of controlled hypotension (List separately in addition to code for primary anesthesia procedure)
99140 Anesthesia complicated by emergency conditions (specify) (List separately in addition to code for primary anesthesia procedure)
This code is eligible for separate reimbursement at the allowed amount. Separately in addition to code for primary anesthesia proedure. Thi code are assigned a status indicator of "B" (bundled code) on the CMS Physician Fee schedule, and are not eligible for separate reimbursement uder Medicare guidelines. As per CMS, the value for the qualifying circumstances has already been included in the RVUs for the primary anesthesia procedure codes. Payment for these services is always included in payment for other services not sprcified. There are no RVUs or payment amoount for these codes and separate payment is not made.
Coding Guidelines
CPT Assistant:
“Question: What are "qualifying circumstances for anesthesia," and when are they reported?
Answer: Codes 99100-99140 are add-on codes that include a list of important qualifying circumstances that significantly affect the character of the anesthesia service provided. These circumstances would be reported as additional procedure numbers qualifying an anesthesia procedure or service. More than one code in the section may be selected, if applicable. Codes 99100-99140 are listed in the Anesthesia guidelines in the CPT codebook.” (AMA2)
Medicare Physician Fee Schedule:
Qualifying circumstances CPT codes 99100 – 99140 are assigned a status indicator of “B” (bundled code) on the CMS Physician Fee Schedule, and are not eligible for separate reimbursement under Medicare guidelines. Per CMS, the value for these qualifying circumstances has already been included in the RVUs for the primary anesthesia procedure codes.
Reimbursement Guidelines
Commercial lines of business
Effective for claims processed on or after 2/25/2016, Moda Health does not separately reimburse for CPT codes 99100 – 99140. This is based on their status indicator of “B” (bundled code) on the CMS Physician Fee Schedule.
CPT codes 99100 – 99140 will deny to provider liability with denial codes:
EX: 2M0 Service/supply is considered bundled or incidental. Not eligible for separate payment. Always bundled into a related service.
CARC: 97 The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.
RARC: M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
99100+ (Anesthesia for patient of extreme age, under 1 year and over 70 {list separately in addition to code for primary procedure}) bundles with 00326 (Anesthesia for all procedures on the larynx and tracheas in children less that 1 year of age), 00834 (Anesthesia for hernia repair in the lower abdomen (not otherwise specified, under 1 year of age) and 00836 (Anesthesia for hernia repair in the lower abdomen not otherwise specified, infants less that 37 weeks gestational age at birth and less than 50 week gestation age at time of surgery).