CommercialReimbursementHigh impact
Special Alert October 2025 - Neuraxial Labor Analgesia/Anesthesia
Providence Health Plan·Anesthesiology, OB-GYN·Provider News
Effective date
Dec 1, 2025
We identified it
Oct 1, 2025
Summary
Effective December 1, 2025, Providence Health Plan will cap reimbursement for CPT 01967 (neuraxial labor analgesia/anesthesia for planned vaginal delivery) at 480 units (480 minutes) for all non-Medicaid lines of business. Any units billed in excess of this cap will be denied. This is a new policy that introduces a hard limit on anesthesia time reimbursement for this procedure.
Action Required
By November 1, 2025: Billing team must update billing software to implement a 480-unit cap for CPT 01967 claims submitted to Providence Health Plan non-Medicaid lines of business. Configure system to flag or auto-deny any claims exceeding 480 units for this code. Anesthesia providers must be notified to monitor anesthesia time documentation for labor epidurals and ensure total time in attendance does not exceed 480 minutes per patient encounter. Update internal billing guidelines and provider communication materials. Claims submitted after December 1, 2025 that exceed 480 units will be automatically denied by the payer.