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CO HCPF Medical-Surgical Billing Manual — Anesthesia Services
AnesthesiaServices
Anesthesiabenefitsareprovidedformedical,surgicalandradiologicalprocedures.Anesthesiareimbursementisbasedonactualanesthesiatime.Providersshouldbilltheexactnumberofminutesduringwhichserviceswereprovided.One(1)unitofserviceequalsfifteenminutesofanesthesiatime.Anesthesiatimebeginswhentheanesthetiststartsmemberpreparationforinductionintheoperatingroomoranequivalentareaandendswhenthemembermaybesafelyplacedunderpost-operativecare.Noadditionalbenefitsareprovidedforemergencyconditionsorthemember'sphysicalstatus.
Reimbursementforanesthesiaincludesallofthefollowing:
Preoperativeevaluation
Postoperativevisits
Anesthesiacareduringtheprocedure
Fluidand/orbloodadministration
Interpretationofbloodgases
Anynecessarynon-invasivemonitoringprocedures(e.g.,EKG)
Nerveblocksforanestheticpurposesareprocessedasgeneralanesthesia.Nerveblocksfordiagnosticortherapeuticpurposesareprocessedassurgicalprocedures.
AnesthesiaservicesrenderedbyaCRNAwhoissupervisedbyananesthesiologistmaybebilledbyeithertheCRNAorthesupervisinganesthesiologistbutnotboth.IftheservicesarebilledbyboththeCRNAandtheanesthesiologist,thesecondclaimwillbedeniedasaduplicate.
Thefollowingservicesareconsideredincidentaltotheanesthesiaserviceandnoseparatebenefitisallowed:
Totalbodyhypothermiaincombinationwithorinadditiontoprocedurecodesdescribedas"open"or"bypass"
Endotrachealintubationorextubation
PaymentAnesthesiapaymentisthelesserofthebilledamountandtheamountcalculatedasfollows:(RelativeValue+)xAllowedAmountTheRelativeValueandAllowedAmountforeachanesthesiaCPTcodearefoundontheHealthFirstColoradoPhysicianFeeSchedule.
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Localinfiltration,digitalblock,ortopicalanesthesiaadministeredbytheoperatingsurgeonisincludedinthesurgicalreimbursementandnoadditionalbenefitisavailable.IVvaliumorIVpentothalisabenefitwhenadministeredbythesurgeon.Forobstetricaldeliveries,localpudendalandparacervicalblockanesthesiaisincludedintheobstetricalpaymentandnoadditionalbenefitsareallowedforthedeliveringphysician.
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Epiduralanesthesiabyaproviderotherthanthedeliveringpractitionerisacoveredbenefit.Membercontacttimemustbedocumentedontheclaim.Claimsformorethan120minutes(eight[8]ormoretimeunits)ofdirectmembercontactepiduraltimerequireanattachedcopyoftheanesthesiarecord.
WhenCPTcodes01967and01968areperformedacrosstwo(2)datesofservice,bothproceduresshouldbereportedwithadatespanthatincludesbothdatesofservice.
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Standbyanesthesiaisabenefitinconjunctionwithobstetricaldeliveries,subduralhematomas,femoralorbrachialarteryembolectomies,memberswithaphysicalstatusoffour(4)orfive(5),insertionofacardiacpacemaker,cataractextractionand/orlensimplant,percutaneoustransluminalangioplasty,andcornealtransplant.Unusualcircumstancesorexceptionstoallowabenefitforstandbyanesthesiaforotherproceduresmustbefullydocumented.Documentationmustbesubmittedwithclaim.
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Familyplanningservicesincludingintrauterinedevices,implants,diaphragms,andcontraceptivedrugsarebenefitsofHealthFirstColorado.
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FootcareservicesarebenefitsofHealthFirstColoradowhetherprovidedbyaphysicianorlicensedpodiatrist.Claimsforservicesprovidedtoduallyeligible(i.e.,HealthFirstColoradoandMedicare-eligible)membersaresubmitteddirectlytothefiscalagent.
IfthebilledserviceisroutinefootcareandisidentifiedbytheMedicareprogramasnon-reimbursable,usetheGYmodifiertoidentifyroutinepodiatricfootcareservicesthatarenotcoveredbyMedicare.TheMedicarenon-coveredservicesfieldontheclaimrecordmustalsobecompleted.
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Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
505709242d85e0d8b8575ef1cdeff36330bb0194b603a54756dd8247100ea501
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