CPT 00731: Anesthesia for Upper GI Endoscopy, 5 Base Units
00731 reports anesthesia for an upper gastrointestinal endoscopy that no more specific code describes. It carries 5 base units and is priced from anesthesia time, not from a fee schedule amount.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026In short: 00731 has 5 base units, is paid on base plus time units, and covers the EGD whether or not a biopsy is taken. A same-session EGD and colonoscopy is billed as 00813, and QS marks monitored anesthesia care.
What Does CPT 00731 Report?
00731 reports anesthesia for an upper gastrointestinal endoscopic procedure not otherwise specified, which is how the CMS short label reads. It covers the EGD itself, whether or not a biopsy is taken, because anesthesia codes describe a general anatomic area rather than the surgeon's exact procedure (NCCI Chapter II). The endoscopist's code for a biopsy is 43239.
| Code | CMS short label | Base units |
|---|---|---|
| 00731 | Anesthesia, upper GI endoscopic procedure, not otherwise specified | 5 |
| 00732 | Anesthesia, upper GI endoscopic procedure with ERCP | 6 |
| 00811 | Anesthesia, lower intestinal endoscopic procedure, not otherwise specified | 4 |
| 00812 | Anesthesia, lower intestinal endoscopic screening colonoscopy | 3 |
| 00813 | Anesthesia, combined upper and lower GI endoscopic procedure | 5 |
Status J means the fee schedule file shows no RVUs and no payment amounts, so the claim is priced from base units, time units and the locality conversion factor. 00731 is not in the October 2026 practitioner MUE table.
Do I Bill 00731 and 00811 for an EGD and Colonoscopy in One Session?
No. When the same practitioner gives anesthesia for an EGD and a colonoscopy in one session, report the combined code 00813, with 5 base units. NCCI Chapter II says that for Medicare only one anesthesia code is reported unless the code is an add-on, and that you do not report several codes when a single code describes the services.
If the colonoscopy is a screening that stays a screening, the lower scope has its own screening code and Medicare rules, covered on the 00811 page. Compare the knee code 01402 for the unit math that applies to any anesthesia line.
Is Anesthesia for an EGD Monitored Anesthesia Care or Moderate Sedation?
Monitored anesthesia care, known as MAC, is a service in which an anesthesia practitioner monitors the patient's vital signs in anticipation of needing general anesthesia. 00731 is billed whatever the type of anesthesia, but MAC has its own reporting rules. Chapter 12 section 50H pays it on the same basis as other anesthesia when it is reasonable and necessary, and NCCI Chapter II says CMS recognizes it as payable on that condition.
Moderate sedation is different. Chapter 12 section 50J defines it as drug-induced depression of consciousness in which the patient responds purposefully, and says it does not include MAC. When the endoscopist gives the sedation, it is reported by that physician as moderate sedation and not as 00731. NCCI also bars separate anesthesia payment, with limited exceptions, when the physician doing the procedure gives the anesthesia.
Use QS on the line to show MAC, in addition to actual time and one payment modifier. Two further modifiers describe MAC cases in the CMS list: G8, MAC for deep, complex, complicated or markedly invasive surgical procedures, and G9, MAC for a patient with a history of severe cardio-pulmonary condition.
The anesthesiologist works alone. Time units are 25 / 15 = 1.67, rounded to 1.7. The conversion factor is the 2026 Alabama locality value from the CMS ANES2026 file.
What Does the Chart Need for 00731?
The anesthesia record has to show who did what. For a medically directed case, Chapter 12 section 50C requires the physician to document the pre-anesthetic examination and evaluation, the post-anesthesia care, and presence during some of the monitoring and the most demanding parts, including induction and emergence.
- Start and end times that match the anesthesia time definition, reported in minutes
- Why an anesthesia practitioner was needed rather than sedation by the endoscopist
- The payment modifier facts: who was present, and how many cases the physician directed
- Any resident involvement, which adds GC
How Does 00731 Appear on the Claim?
On the CMS-1500, Item 24D holds 00731 with the payment modifier and QS if MAC, Item 24G the minutes, and Item 24B the place of service. Payment modifiers are AA, QK, QY, QX and QZ, set out on the 01402 page.
How Are the Anesthesia Minutes and Modifiers Entered for 00731?
Anesthesia is the one place where Item 24G is not a count of services. Chapter 26 says to show elapsed time in minutes there and to convert hours into minutes. A 1 hour 42 minute case is entered as 102, with 00731 in Item 24D beside the payment modifier. Item 24E points to the reason for the upper endoscopy, the same diagnosis the endoscopist reports.
RVU26D gives 00731 status J, which the file defines as an anesthesia service with no RVUs and no payment amounts shown. Payment comes from base units, time units and the anesthesia conversion factor, not from this row. The practitioner MUE table has no row for 00731, so there is no unit cap to cite.
Example: Anesthesia starts at 8:10 and ends at 9:52 on 10/22, so 102 minutes. The line reads 00731, modifier QK, pointer A (K21.9), 102 in Item 24G, $640.00. Entering 1.7 for hours instead of 102 minutes is a typical way a line is returned as incomplete under CO-16.
Why Is 00731 Denied?
| Code | What X12 says | What usually causes it |
|---|---|---|
| CARC 4 | The procedure code is inconsistent with the modifier used | No payment modifier, or QS without one |
| CARC 97 | The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated | The endoscopist billed anesthesia for the same procedure, or 00731 beside 00813 |
| CARC 50 | These are non-covered services because this is not deemed a medical necessity by the payer | MAC without documentation of why it was needed |
| CARC 59 | Processed based on multiple or concurrent procedure rules (for example concurrent anesthesia) | Medically directed rate applied to QK |
If these denials keep coming back, our denial management team can work them. See also gastroenterology billing.
Related Codes
- Physician Fee Schedule relative value files, RVU26D (October 2026) · CMS
- CY 2022 Anesthesia Base Units by CPT code (unchanged for CY 2026) · CMS
- Anesthesiologists Center: anesthesia base units and conversion factors · CMS
- Medicare NCCI Medically Unlikely Edits, practitioner services table, effective 10-01-2026 · CMS
- 2026 NCCI Medicare Policy Manual, all chapters (revision 1/1/2026) · CMS
- Medicare Claims Processing Manual, Chapter 12: Physicians/Nonphysician Practitioners · CMS
- Medicare Claims Processing Manual, Chapter 26: Completing and Processing Form CMS-1500 Data Set · CMS
- HCPCS quarterly update, October 2026 alpha-numeric file · CMS
- Claim Adjustment Reason Codes · X12
We check every rule, code and deadline against the official source. See our editorial policy.
Common Questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01How do I bill anesthesia for upper GI endoscopy?
Report 00731 with the payment modifier that matches who provided the care, such as AA, QK, QX or QZ, and the actual anesthesia minutes in Item 24G. Add QS if it was monitored anesthesia care. Base units are 5, and the endoscopist's biopsy code does not change the anesthesia code.
02Can I bill 00731 with 00811 on the same day?
Not for the same session. NCCI Chapter II says Medicare accepts one anesthesia code unless an add-on applies, and not several codes when one describes the services. A combined upper and lower endoscopy is reported with 00813, which carries 5 base units.
03What does the QS modifier mean on 00731?
QS marks monitored anesthesia care. Chapter 12 section 50I says it is informational and that you must still report actual anesthesia time and one of the payment modifiers on the line. A physician or a CRNA can report it, so it never replaces AA, QK, QX or QZ.
04Can the gastroenterologist bill anesthesia for their own EGD?
No separate anesthesia payment is made when the physician performing the procedure also gives the anesthesia. NCCI Chapter II says that payment is included in the procedure. Moderate sedation by that physician may be reported separately, but it is not 00731.
05How many base units does 00731 have compared with ERCP anesthesia?
00731 has 5 base units in the CMS base unit file. The ERCP code 00732 has 6, and the combined upper and lower endoscopy code 00813 has 5. CMS states the base units are unchanged for CY 2026, so the same values apply all year.
Endoscopy Anesthesia Claims Coming Back?
We check the payment modifier, QS, minutes and the single anesthesia code against the record before the claim goes out.