Medicare provides payment to CRNAs and AAs. CRNAs and AAs may bill directly for their services or have payment made to an employer or an entity under which they havea contract. This could be a hospital, physician, group practice or Ambulatory Surgical Center (ASC).
Reimbursement for CRNA services is made only on an assignment basis.
For payment purposes, CRNAs include both qualified anesthetists and AAs. An AA is a person who:
Is permitted by state law to administer anesthesia and who has successfully completed a six-year program for AAs of which two years consist of specialized academic and clinical training in anesthesia.
A CRNA is a registered nurse who is licensed by the state in which the nurse practices and who:
Is currently certified by the Council on Certification of Nurse Anesthetists or the Council or Recertification of Nurse Anesthetists.
Has graduated within the past 18 months from a nurse anesthesia program that meets the standards of the Council of Accreditation of Nurse Anesthesia Educational Programs and is awaiting initial certification.
All claims for anesthesia furnished by qualified anesthetists must indicate:
The duration of the procedure in minutes – how much time elapsed from the preparation of the patient for induction to the moment when the anesthetist was no longer in attendance.
Whether an anesthesiologist or other physician (except the surgeon) functioning as an anesthesiologist medically directed the anesthesia. Use the QX or QZ modifier to fulfill this requirement.
QX – Anesthesia; CRNA medically directed
QZ – Anesthesia; CRNA not medically directed
QS – Monitored Anesthesia Care (MAC) services (can be billed by a CRNA or a physician)
Anesthesiologists should submit their services for medical direction on a separate claim from the services of the CRNA