In this article, we shared billing guidelines for anesthesia payment at personally performed rate and calculation of anesthesia time units. We referred Medicare billing guidelines from Medicare claims processing manual chapter 12.50 i.e., payment for anesthesiology services. You can refer payer specific billing guidelines to receive accurate anesthesia payment at personally performed rate. The A/B Medicare Administrative Contractor (MAC) determines the fee schedule payment, recognizing the base unit for the anesthesia code and one time unit per 15 minutes of anesthesia time if:
- The physician personally performed the entire anesthesia service alone;
- The physician is involved with one anesthesia case with a resident, the physician is a teaching physician;
- The physician is involved in the training of physician residents in a single anesthesia case, two concurrent anesthesia cases involving residents or a single anesthesia case involving a resident that is concurrent to another case that meets the requirements for payment at the medically directed rate;
- The physician is continuously involved in a single case involving a student nurse anesthetist;
- If the physician is involved with a single case with a qualified nonphysician anesthetist (a certified registered nurse anesthetist (CRNA) or an anesthesiologist’s assistant)), A/B MACs may pay the physician service and the qualified nonphysician anesthetist service in accordance with the requirements for payment at the medically directed rate; Or
- The physician and the CRNA (or anesthesiologist’s assistant) are involved in one anesthesia case and the services of each are found to be medically necessary. Documentation must be submitted by both the CRNA and the physician to support payment of the full fee for each of the two providers. The physician reports the AA modifier and the CRNA reports the QZ modifier.
Anesthesia practitioner means:
- a physician who performs the anesthesia service alone,
- a CRNA who is furnishing services that do not meet the requirements for payment at the medically directed rate,
- a qualified nonphysician anesthetist who is furnishing services that meet the requirements for payment at the medically directed rate.
The physician who medically directs the qualified nonphysician anesthetist would ordinarily report the same time as the qualified nonphysician anesthetist reports for the service.
Calculation of Anesthesia Time Units
Anesthesia time is defined as the period during which an anesthesia practitioner is present with the patient. It starts when the anesthesia practitioner begins to prepare the patient for anesthesia services in the operating room or an equivalent area and ends when the anesthesia practitioner is no longer furnishing anesthesia services to the patient, that is, when the patient may be placed safely under postoperative care.
Anesthesia time is a continuous time period from the start of anesthesia to the end of an anesthesia service. In counting anesthesia time for services furnished, the anesthesia practitioner can add blocks of time around an interruption in anesthesia time as long as the anesthesia practitioner is furnishing continuous anesthesia care within the time periods around the interruption.
Actual anesthesia time in minutes is reported on the claim. For anesthesia services furnished, the A/B MAC computes time units by dividing reported anesthesia time by 15 minutes. Round the time unit to one decimal place. The A/B MAC does not recognize time units for CPT code 01996(daily hospital management of epidural or subarachnoid continuous drug administration).
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Reference: Medicare Claims Processing Manual Chapter 12