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Many health care stakeholders, especially anesthesiologists, rely upon qualifying circumstance payments for perioperative care that is not covered by a coding system that is based upon typical patients and standard conditions. Prime examples of such payment gaps include the care of very young children under one year of age as well as those when emergency services require extraordinary efforts. Hospitals and other facilities depend on anesthesiologists not just to provide these essential services but to optimize outcomes under challenging circumstances that mandate expanded resources and work intensity.
Qualifying circumstances are add-on codes that indicate an anesthesia service provided under particularly difficult circumstances due to factors such as extraordinary condition of patient, notable operative conditions, and unusual risk factors. These codes cover the anesthesia services for surgical procedures performed on children under one year of age or frail elderly patients (99100) as well as anesthesia complicated by utilization of total body hypothermia (99116), utilization of controlled hypotension (99135), and by emergency conditions (99140). The codes are used, for example, in emergency cases where unscheduled extensive pre-anesthesia set-up and perioperative services are required.
ASA supports and advocates for Medicare and private payers to use and pay for qualifying circumstances.
Anesthesiologists are encouraged to better understand how their services are paid and the importance of appropriate documentation. Anesthesiologist group and practice leaders should routinely assess their contracts with and payments from insurance companies. When unfair changes to payer policies are proposed, anesthesiologists and their groups need to quickly assess the impact such policies would have on revenue, service line coverage, and patient access to timely care.
To sign up for alerts and be engaged on payment issues, please contact ASA Advocacy at advocacy@asahq.org.
This page was last updated November 6, 2025.
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You do not have to make a payment at this time, but you can reach out to your practice/group leader to find out when they plan to pay your dues. Email or call the ASA Support team for assistance: (630) 912-2552 or info@asahq.org.
