Base UnitsEach anesthesia code (procedure codes 00100-01999) is assigned a base unit value by the American Society of Anesthesiologists (ASA) and used for the purpose of establishing fee schedule allowances.Anesthesia services are paid on the basis of a relative value system, which include both base and actual time units. Base units take into account the…
Payment at Personally Performed Rate The fee schedule payment for a personally performed procedure is based on the full base unit and one time unit per 15 minutes of service if the physician personally performed the entire procedure. Modifier AA is appropriate when services are personally performed. Payment at Medically Directed Rate When the physician…
Monitored anesthesia care involves intraoperative monitoring by a physician or qualified individual under the medical direction of a physician or of the patient’s vital physiological signs in the anticipation of the need for administration of general anesthesia or of the development of adverse physiological patient reaction to the surgical procedure. It also includes the performance…
If a teaching anesthesiologist is involved in a single procedure with one resident, the anesthesia services will be paid at the personally performed rate. The teaching physician must document in the medical records that he or she was present during all critical (or key) portions of the procedure. The teaching physician’s physical presence during only…
A Physician, a Certified Registered Nurse Anesthetist (CRNA) or Anesthesiologist Assistant under the medical supervision of a physician, may provide anesthesia services.Provider QualificationsPhysician – AnesthesiologistPhysician is defined as a doctor of medicine who is legally authorized to practice in the State in which he/she performs services. The issuance of a license by a State to…
Modifier Description % of Allowed Charge AA Anesthesia services performed personally by the anesthesiologist 100 percentAD Medical supervision by a physician; more than four concurrent anesthesia procedures. (Three base units + actual time units allowed) 65 percentQK Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals). 65 percentQY Medical direction of…
Teaching Physician Medicare pays an unreduced fee schedule payment if a teaching anesthesiologist is involved in a single procedure with one resident. The teaching physician must document in the medical records that he was present during all critical or key portions of the procedure. The teaching physician’s physical presence during only the preoperative or postoperative…
Anesthesia Payment & Billing Information Time and Points Eligible Anesthesia Procedures Defined Blue Cross and Blue Shield of Texas has 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…
Anesthesia Payment Medical Supervision If an anesthesiologist is medically directing more than four CRNAs, the Medicare regulations indicate that the service must be billed as medically supervised as opposed to medically directed anesthesia services. The anesthesiologist should bill with the AD modifier and the CRNA should bill with the QX modifier. The Medicare payment to…
Anesthesia Billing for Obstetrics In many cases the Anesthesiologist or the CRNA places the epidural and leaves the patients side once dosage has been tested, checking back only periodically throughout labor progression. Different anesthesia groups document this in varying forms. Due to widespread variances in the fee calculation of these services, tracking payment trends accurately…
