CommercialReimbursementMedium impact
Special Alert October 2025 - Neuraxial Labor Analgesia/Anesthesia
Providence Health Plan·OR · Anesthesiology, OB-GYN·Provider News
Effective date
Dec 1, 2025
We identified it
Oct 6, 2026
Summary
Effective December 1, 2025, Providence Health Plan will cap reimbursement for CPT code 01967 (neuraxial labor analgesia/anesthesia for planned vaginal delivery) at 480 units for all non-Medicaid lines of business. Units billed in excess of this cap will be denied. This is a new policy that introduces a hard unit limit where previously no such cap existed.
Action Required
Previously due December 1, 2025 (date passed; verify current applicability): Billing team should implement a claims-processing control in the billing system to flag and prevent submission of CPT 01967 claims exceeding 480 units for all Providence Health Plan non-Medicaid lines of business. Anesthesia providers must verify that total minutes of anesthesia time reported in the units column do not exceed 480 units per claim for labor analgesia/anesthesia cases. Units billed in excess of 480 will be denied by the plan. Note: Medicaid and OHP claims are reimbursed at a flat rate under OAR 410-130-0368 and are not subject to this unit cap.