The codes
| Code | Used for | Base units |
|---|---|---|
| 01967 | Neuraxial labor analgesia for planned vaginal delivery | 5 |
| 01968 | Add-on: cesarean delivery after labor epidural | 2 |
| 01969 | Add-on: cesarean hysterectomy after 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.
Time is the hard part
A labor epidural can run for many hours, and you're not at the bedside the whole time. Payers handle this in different ways:
- Some pay actual time while you're providing care, the same as surgical anesthesia
- Some pay a set number of units for the whole labor, whatever its length
- Some pay time up to a cap
- Some count face-to-face time differently from total epidural time
The method can change from one payer to the next in the same state. Get each payer's rule in writing and set up your billing to match it.
When labor ends in a cesarean
Bill 01967 for the labor epidural, then the add-on code for the cesarean. Don't bill 01961 as well. That code is for a cesarean without a prior labor epidural. See cesarean section anesthesia billing.
Documentation tips
- Record placement time, top-ups and every in-person check
- Note who placed the epidural and who managed it later, if that changed
- Record the time of delivery or when the catheter was removed
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