Anesthesia Payment & Billing Information – BCBS
Time and Points Eligible Anesthesia Procedures Defined
HMO Blue Texas and Blue Cross and Blue Shield of Texas have determined that certain anesthesia procedures will be reimbursed on time and points methodology.
Procedures that are not included on the Anesthesia Time & Points Eligible List will not be reimbursed using time and points methodology. If a procedure is not on this list, and it is submitted using anesthesia indicators for Time & Points such as:
- using an anesthesia modifier, or
- using time on the claim, or
- if submitted on a non-HIPAA claim format, (Type of Service = 7),
then the provider may receive a denial message for that procedure noting that the service is not eligible for time and points payment methodology.
Services involving administration of anesthesia should be reported by the use of the Current Procedural Terminology (CPT) anesthesia five-digit procedure codes, American Society of Anesthesiologists (ASA) or CPT surgical codes plus a modifier. HMO Blue Texas and Blue Cross and Blue Shield of Texas will require that the appropriate anesthesia modifier be filed on anesthesia
An anesthesiologist or a CRNA can provide anesthesia services. The anesthesiologist and the CRNA can bill separately for anesthesia services personally performed. When an anesthesiologist provides medical direction to a CRNA, both the anesthesiologist and the CRNA should bill for the
appropriate component of the procedure performed. Each provider should use the appropriate anesthesia modifier.
In keeping with the American Medical Association Current Procedural Terminology (CPT) Book, services involving administration of anesthesia include the usual pre-operative and post-operative visits, the anesthesia care during the procedure, the administration of fluids and/or blood and the usual monitoring services (e.g., ECG, temperature, blood pressure, oximetry, capnography and mass spectrometry). Intra-arterial, central venous, and Swan-Ganz catheter insertion are allowed separately.
Modifier Information Billed by an Anesthesiologist
AA Anesthesia services personally performed by the anesthesiologist
AD Supervision, more than four procedures
QK Medical Direction of two, three or four concurrent anesthesia procedures
QY Medical Direction of one CRNA by an anesthesiologist
Modifier Information Billed by a CRNA
QX Anesthesia, CRNA medically directed
QZ Anesthesia, CRNA not medically directed