Sunday, June 13, 2010

How payment has been calculated for anethesia services

Reimbursement for anesthesia services shall be made at the provider’s usual charge or the anesthesia reimbursement allowance (ARA) listed in Part A, Section X in this manual.

a. Methodology for calculating the anesthesia reimbursement allowance (ARA) for procedures that are listed basic value (BV) + time (TM).

(1) Select the applicable anesthesia procedure code and basic value.
(2) Determine the time units according to Section IX.A.1.b.(3) (ten [10] minutes = one
[1] time unit for an anesthesiologist and fifteen [15] minutes = one [1] time unit for a CRNA).
(3) Any minutes that exceed a whole unit are counted as partial units (fractions of units), such as one (1) minute is one-tenth (1/10) unit for an anesthesiologist and onefifteenth (1/15) unit for a CRNA.
(4) Determine any additional units that are justified by the physical status modifiers or qualifying circumstance.
(5) Add the basic value, time units, physical status modifier and any applicable
qualifying circumstances to determine the total anesthesia value.
(6) Multiply the total anesthesia value by the conversion factor of $29.49 to obtain the anesthesia reimbursement allowance.

No comments:

Post a Comment

Popular Posts