Monday, June 28, 2010

Payment for Medically directed and non medically directed rate

PAYMENT AND REIMBURSEMENT

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 is medically directing a qualified anesthetist (CRNA, Anesthesiologist
Assistant) in a single anesthesia case or a physician is medically directing 2, 3, or 4 concurrent
procedures, the payment amount for each is 50% of the allowance otherwise recognized had the
service been performed by the physician alone.

These services are to be billed as follows:
1. The physician should bill using modifier QY, medical direction of one CRNA by a physician or QK, medical direction of 2, 3, or 4 concurrent procedures.

2. The CRNA/Anesthesiologist Assistant should bill using modifier QX, CRNA service with medical direction by a physician.


Payment at Non-Medically Directed Rate

In unusual circumstances, when it is medically necessary for both the anesthesiologist and the
CRNA/Anesthesiologist Assistant to be completely and fully involved during a procedure, full
payment for the services of each provider are allowed. Documentation must be submitted by
each provider to support payment of the full fee.

These services are to be billed as follows:

1. The physician should bill using modifier AA, anesthesia services personally performed by
anesthesiologist, and modifier 22, with attached supporting documentation.

2. The CRNA/Anesthesiologist Assistant should bill using modifier QZ,
CRNA/Anesthesiologist Assistant services; without medical direction by a physician, and
modifier 22, with attached supporting documentation.

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