Medicare reimbursement formula for different type of Anesthesia


Code Set

Medicare uses anesthesia codes and base values adopted from the list values established by the American Society of Anesthesiologists (ASA).

General Information

Anesthesia administration includes the following services:

** Preoperative and postoperative visits
** Anesthesia care during the procedure
** Administration of fluids and blood
** Usual monitoring (e.g., ECG, temperature, blood pressure, oximetry, capnography, mass spectrometry) as defined by ASA (American Society of Anesthesiologists) and/or CPT guidelines.

General Anesthesia is personally performed by an anesthesiologist or CRNA/AA (medically directed by an anesthesiologist, or medically supervised by an anesthesiologist).

Outlined below is general information related to the reimbursement formulas used by Medicare:

Personally Performed and Medically Directed Formula

(ASA Base Units) + (Total Time / 15 rounded up to a whole unit x Current Conversion Factor

Medically Supervised

Allow three (3) base units, and one (1) additional base unit when it is demonstrated that the physician was present at the induction x Current Conversion Factor

Personally Performed – 100% of the allowed amount

Medically Directed – 50% of the allowed amount

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