HAP’s Anesthesia Reimbursement Policy Update
HAP has updated the neuraxial labor analgesia reimbursement calculations section in their anesthesia policy to be consistent with industry standards.
Effective January 1, 2021, regardless of the date of service, please follow the guidelines below.
- HAP will reimburse neuraxial labor analgesia (CPT code 01967) based on base unit value plus time units. Service should be reported in total minutes and start and stop times. HAP will calculate one 15-minute unit for each 60 minutes of time reported. HAP will round up after 30 minutes and round down for 29 minutes or less. Modifying units for physical status modifiers and qualifying circumstance codes will not be considered in addition to the base unit value for labor or delivery anesthesia services.
- Obstetric Add-On Codes: Obstetric anesthesia often involves extensive hours and the transfer of anesthesia to a second physician. Due to these unique circumstances, HAP will consider for reimbursement, add-on CPT codes 01968 and 01969 (c-section anesthesia) when billed with the primary CPT code 01967 (by the same or different individual and qualified physician) for the same member. According to the ASA Crosswalk® time for add-on code 01968 or 01969 is reported separately as a surgical anesthesia service and is not added to the time reported for the labor anesthesia service.
Click here to read the full update and announcement released by HAP.