Payment and billing at personally performed rate, at medically directed rate and at non-medically directed rate for anesthesia services are explained below. 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…
PAYMENT AND REIMBURSEMENT – Anesthesia Payment at Medically Supervised RateOnly three (3) base units per procedure are allowed when the anesthesiologist is involved in rendering more than four (4) procedures concurrently or is performing other services while directing the concurrent procedures. An additional time unit can be recognized if the physician can document he/she was…
Payment RulesThe fee schedule allowance for anesthesia services is based on a calculation that includes the anesthesia base units assigned to each anesthesia code, the anesthesia time involved, and appropriate area conversion factor. The following formulas are used to determine payment:• Participating Physician not Medically Directing (Modifier AA)(Base Units + Time Units) x Participating Conversion…
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…
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…
The HMO Blue Texas and Blue Cross and Blue Shield of Texas maximum allowable fees for services billed as MD supervision of a CRNA are as follows: Modifier QY reimbursement: $325.52 (MD supervision of a CRNA) Modifier QK reimbursement: $310.01 (MD supervision of a CRNA) Modifier AD reimbursement: $162.76(MD supervision of a CRNA) OB Time…
EMERGENCY ANESTHESIA Additional payment is allowed to anesthesiologists and non-medically directed certified registerednurse anesthetists for providing anesthesia for surgery on an emergency basis. The ASA recommended payment policy of two additional base units is followed. CPT code 99140 must be billed one unit in order to receive payment for this service.
Concurrent Medically Directed Procedures Concurrency is defined with regard to the maximum number of procedures that the physician is medically directing within the context of a single procedure and whether the other procedures overlap each other. Concurrency is not dependent on each of the cases involving a Medicare patient. For example, if an anesthesiologist directs…
Payment Conditions for Anesthesiology Services Medical Direction For a single anesthesia case involving both a physician medical direction service and the service of the medically directed CRNA, the payment amount for each service may be no greater than 50 percent of the allowance. The total payment for both may not exceed the amount that would…
PAYMENT AND REIMBURSEMENT Payment at Personally Performed Rate The fee schedule payment for a personally performed procedure is based on the full base unitand one time unit per 15 minutes of service if the physician personally performed the entireprocedure. Modifier AA is appropriate when services are personally performed. Payment at Medically Directed Rate When the…
