CPT 99100
Anesthesia add-on for extreme age
A 'qualifying circumstances' add-on to an anesthesia charge for a patient under one year old or over seventy. It adds a fixed number of base units to the anesthesia fee. Medicare does not pay it; many commercial plans do.
Where this line goes wrong
Age is the only criterion
If the patient was between one and seventy, the code does not apply. It is a small line but an easy one to check.
Check it, then ask
- 1
Check the patient's age on the date of service against the code's age limits.
- 2
If your insurer does not pay qualifying circumstances codes, ask the provider whether they are permitted to bill you for the denied amount under their contract.
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What is a qualifying circumstances code?
An add-on for conditions that make anesthesia harder: extreme age (99100), deliberate hypothermia (99116), controlled hypotension (99135), or an emergency (99140). Each adds base units to the anesthesia fee.
Sources
This page explains a billing code in general terms. It is not a coding, legal or medical opinion about your bill, and the code descriptions are mediloop's own plain-English summaries, not the official CPT descriptors, which are owned by the American Medical Association. Whether a charge was correct depends on the record of your visit and your payer's rules.