Anesthesia Services

Updated: January 2026

Purpose

This policy outlines covered, non-covered, and billing requirements related to anesthesia services provided to ND Medicaid members.

Applicability

Eligible Providers

To receive payment from ND Medicaid, the eligible servicing and billing providers must be enrolled with ND Medicaid on the date of service, and their National Provider Identifiers (NPIs) must be active in their Medicaid enrollment records. Servicing providers acting as a locum tenens provider must be enrolled with ND Medicaid, and services they provide must be billed with their NPI. Please refer to provider enrollment for additional details on enrollment eligibility and supporting documentation requirements.

Eligible Members

Providers are responsible for verifying a member’s eligibility before providing services. Eligibility can be verified using the ND Medicaid MMIS Portal or through the Automated Voice Response System by dialing 1.877.328.7098.

Refer to the Member Eligibility Manual for additional information regarding eligibility including information regarding limited coverage categories. 

Covered Services and Limits

General Provider Policies

The General Provider Policies details basic coverage requirements for all services. Basic coverage requirements include:

• The provider must be enrolled in ND Medicaid;
• Services must be medically necessary;
• The member must be eligible on the date of service; and
• If applicable, the service has an approved service authorization. 

The Procedure Code Look-up Tool  can be used to identify if a procedure code is covered by ND Medicaid along with code specific details such as Ordering/Referring/Prescribing (ORP) requirements, Service Authorization requirements, and current rates. 

Anesthesia services are covered for members undergoing surgical or nonsurgical procedures in an outpatient or inpatient setting where the administration of an anesthetic is required. To provide the care deemed appropriate, the type of anesthesia may be any of the following:

• General anesthesia;
• Regional anesthesia;
• Monitored anesthesia care; or
• Moderate sedation.

Global Service

Anesthesia is a global service and includes the following:

• Preoperative and postoperative visits;
• Anesthesia care during the procedure;
• Administration of fluids or blood; and
• Usual monitoring services (ECG, temperature, blood pressure, oximetry, capnography, and mass spectrometry).

Other Anesthesia Servies

ND Medicaid reimbursement for anesthesia services includes pre- and post-operative visits. If an anesthetic is not administered due to surgery cancellation, the anesthesiologist or CRNA may bill an Evaluation and Management (E/M) CPT® code equivalent to the service performed. 

Unusual monitoring forms, such as the placement of intra-arterial and central venous lines and insertion of Swan-Ganz catheters, are not included in the global payment. They are separately reimbursed when billed by anesthesiologists and CRNAs.

Pain management procedures such as post-operative nerve blocks must be conducted face-to-face and limited to one daily service. The appropriate CPT®/HCPCS code must be used when billing this service.

Epidural Anesthesia for Vaginal or Cesarean Section 

Continuous epidural analgesia for labor and vaginal or cesarean delivery. The CPT® code for this service includes epidural catheter placement. The number of minutes the anesthesiologist or CRNA is physically present with the member must be recorded in the unit’s box. ND Medicaid payment for CPT® 01967 will be capped at 75 minutes.

Moderate (Conscious) Sedation 

Moderate conscious sedation procedure codes are eligible for separate reimbursement following current CPT® and NCCI coding guidelines. Moderate conscious sedation codes are time-based procedure codes. Time must be documented to support the reported codes and units. Moderate conscious sedation does not include minimal sedation (anxiolysis), deep sedation, or monitored anesthesia care; these procedures should be reported under 00100-01999.

Medical Direction

Anesthesiologists can be reimbursed for the personal medical direction, as distinguished from supervision, they furnish to CRNAs. In all cases where the anesthesiologist provides medical direction, he or she must be physically present in the operating suite. Medical direction is a billing distinction describing a higher level of physician involvement than medical supervision. North Dakota Medicaid will

cover medical direction services when the anesthesiologist directs CRNAs in two, three, or four concurrent cases and personally performs the following:

• Pre-anesthetic exam and evaluation;
• Prescribes anesthesia plan;
• Participates in anesthesia procedures, including induction and emergence;
• Ensures procedures in the anesthesia plan that he/she does not perform are performed by a qualified anesthetist;
• Monitors the course of anesthesia frequently;
• Remains physically present and available for immediate diagnosis and treatment of emergencies; and
• Provides any indicated post-anesthesia care.

Medical Supervision

Medical supervision occurs when the anesthesiologist is involved in more than 4 concurrent cases and only some of the medical directions listed above are followed.

Service Authorization Requirements

No service authorization required.

Noncovered Services

General Noncovered Services

The Noncovered Services Policy contains a general list of services that are not covered by North Dakota Medicaid.

Noncovered Anesthesia services include:

• Anesthesia administered in association with a non-covered procedure;
• Supervision or medical direction provided by a physician who is not an anesthesiologist; and
• Anesthesia for hysterectomy or sterilization when the proper federal consent has not been obtained. 

Documentation Requirements

General Requirements

Providers must keep legible medical and financial records that fully justify and disclose the extent of services provided and billed to ND Medicaid. Records must be retained for at least 7 years after the last date the claim was paid or denied. Providers must follow the documentation requirements in the Provider Requirements Policy. 

Reimbursement Methodology and Claim Instructions

Timely Filing

ND Medicaid must receive an original Medicaid primary claim within one hundred eighty (180) days from the date of service. The time limit may be waived or extended by ND Medicaid in certain circumstances. The Timely Filing Policy contains additional information.

Third-Party Liability

Medicaid members may have one or more additional source of coverage for health services. ND Medicaid is generally the payer of last resort. Providers must pursue the availability of third-party payment sources. The Third Party Liability Policy contains additional information.

Client Share (Recipient Liability)

Client share (recipient liability) is the monthly amount a member must pay toward the cost of medical services before the Medicaid program will pay for services received. The Client Share Policy contains additional information. 

Reimbursement

A claim for services must be submitted at the provider’s usual and customary charge. Payment for services is limited to the lesser of the provider’s usual and customary charge or the ND Medicaid calculated reimbursement. 

A claim for services must be submitted at the provider’s usual and customary charge. Payment for services is limited to the lesser of the provider’s usual and customary charge or the ND Medicaid calculated reimbursement. 

ND Medicaid uses the most recent Centers for Medicare & Medicaid Services (CMS) list of base values. The base value for anesthesia services includes usual pre-operative and post-operative visits. 

Time units equal the number of minutes from when the patient is prepared to when the anesthetist is no longer in personal attendance or continues to be required. The time minutes submitted on the claim are divided into 15-minute increments (divide time units by 15).

The formula used to calculate payments on anesthesia claim lines is as follows.

(Base units + [time units / 15]) x Conversion factor posted on the Rates and Fee Schedules page. 

Claim Form

Anesthesia services must be billed using the CMS-1500 claim form or the 837P HIPPA compliant X12 format. Detailed claim instructions are available on the ND Medicaid Provider Guidelines, Policies & Manual webpage.

The claim must include the exact number of minutes beginning when the anesthesiologist or CRNA prepares the member for induction and ending when the anesthesiologist or CRNA is no longer in personal attendance. The patient can be safely placed under postoperative supervision.  ND Medicaid will calculate the base units for each procedure.

Anesthesia CPT® codes must be accompanied by one of the following modifiers:

• AA =   Anesthesia services performed personally by anesthesiologist. (This modifier should be used only when the anesthesiologist is involved on a full-time basis in the administration of anesthetic to one patient, with or without the assistance of a CRNA).
• AD =  Medical supervision by a physician: more than four concurrent anesthesia procedures. Payment reduction of 50% applies to this modifier.
• QK = Medical direction by a physician of two, three, or four concurrent anesthesia procedures. Payment reduction of 50% applies to this modifier.
• QX =   CRNA services with medical direction by a physician.
• QY = Medical direction of one qualified non-physician anesthetist by an anesthesiologist. Payment reduction of 50% applies to this modifier
• QZ =   CRNA services without medical direction by a physician.

ND Medicaid does not separately reimburse qualifying circumstance CPT® codes 99100, 99116, 99135, and 99140. Patient Status Modifiers P1-P6 are informational only and do not impact payment.

References

• North Dakota Administrative Code
• North Dakota Century Code
• Code of Federal Regulations

Related Policies

• Ordering/Referring/Prescribing Providers
• Sterilization and Hysterectomy

Frequently Asked Questions

Question: Do anesthesia services require separate out-of-state authorization? 
Answer: No, anesthesia services do not require their own out-of-state authorization. 
The claim will be matched against the out-of-state approval for the surgical  procedure.

Contact

Medical Services
600 East Boulevard Ave 
Bismarck, ND 58505-0250
Phone: (701) 328-2310
Email: dhsmedicalservices@nd.gov

Policy Updates

January 2026

• Entire document
  • Updated text and format to comply with ADA requirements. 
• Related policies
  • Added links to ORP and Sterilization policy.
• Q&A
  • Section added.