The codes
| Code | Used for | Base units |
|---|---|---|
| 01961 | Cesarean delivery only | 7 |
| 01968 | Add-on: cesarean after a labor epidural (with 01967) | 2 |
| 01969 | Add-on: cesarean hysterectomy after a labor epidural | 5 |
Base units shown are the standard values most payers use. Check your payer and the current year's CMS base unit file before relying on them.
Picking the right one
- Scheduled cesarean, or no labor epidural: 01961 with the anesthesia time for the case.
- Labor epidural that turns into a cesarean: 01967 plus 01968. The add-on carries the cesarean time.
Emergencies
If the case was a true emergency, where a delay would have put the mother or baby at serious risk, you may be able to add qualifying circumstance code 99140. The record has to say why it was an emergency. Medicare doesn't pay for qualifying circumstances, but many commercial plans do. See qualifying circumstances.
Watch the physical status
Obstetric patients are often P2 or higher. If your payers pay for physical status, make sure it's recorded and billed. See physical status modifiers.
This article is general information, not billing, legal or tax advice. Payer rules change; always check current guidance.
Sources
- CMS: Medicare Claims Processing Manual, Chapter 12 (Anesthesia)
- Maryland Workers' Compensation Commission: anesthesia base unit values