2025 CPT code 99100
(Active) Effective Date: N/A Revision Date: N/A Anesthesia - Qualifying Circumstances for Anesthesia Medicine Services and Procedures Feed
This add-on code is used with a primary anesthesia procedure code for patients under 1 year or over 70 years old.
Modifiers may apply depending on the circumstances of the anesthesia service. Consult the CPT manual for specific modifier guidelines.
Medical necessity is established by the need for anesthesia for the surgical or medical procedure and the patient's age (under 1 year or over 70 years) increasing the complexity and risk of the anesthesia.
The physician or anesthesiologist must document the patient's age in the medical record. The anesthesiologist performs the anesthetic procedure and documents the patient's condition, operative conditions, and risk factors.
- Medicine Services and Procedures
- Medicine Services and Procedures > Qualifying Circumstances for Anesthesia
In simple words: This code is added to the bill if the patient receiving anesthesia is younger than 1 or older than 70.It's used along with the main anesthesia code to show that the patient's age made the procedure more complex.
CPT code 99100 is an add-on code that is reported in addition to the primary anesthesia procedure code.It is used to indicate that the anesthesia was administered to a patient younger than 1 year of age or older than 70 years of age.The physician must document the patient's age in the medical record for this code to be used.Medicare does not reimburse for this code.
Example 1: A 75-year-old patient undergoes a total hip replacement.Code 99100 is added to the primary anesthesia code because of the patient's age., An 8-month-old infant undergoes a surgical repair of a congenital heart defect. Code 99100 is added to reflect the patient's age as a factor in the anesthesia., A 6-week-old preterm infant requires emergency surgery for necrotizing enterocolitis.Code 99100 is added to the anesthesia billing, reflecting the increased complexity due to the patient's age and condition.
Documentation must include the patient's age, the primary anesthesia procedure code, the details of the anesthetic procedure, the patient's condition, and any relevant risk factors.
** This code is not a stand-alone code; it is always reported in addition to the primary anesthesia procedure code.Proper documentation is crucial for accurate coding and reimbursement.
- Revenue Code: P0 (ANESTHESIA)
- Payment Status: Active, but Medicare does not reimburse
- Modifier TC rule: Not applicable.
- Specialties:Anesthesiology, Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center