ANESTHESIA PAYMENT FORMULA

The allowance for anesthesia services is based on the following formula:

Rev. 01/2010 13 Anesthesia Formula
(Time Units + Base Units) X Conversion Factor = Allowance

Anesthesia time is a continuous time period from the start of anesthesia to the end of an anesthesia service. In counting anesthesia time, 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.

One time unit will be allowed for each 15-minute interval, or fraction thereof, starting from the time the physician begins to prepare the patient for induction and ending when the patient may safely be placed under post-operative supervision and the physician is no longer in personal attendance. Actual time units will be paid; do not round.

The participation status of the physician furnishing the medical direction will determine the conversion factor used to determine the physician's allowance. The participating physician conversion factor is always used to determine the allowance for the anesthesia service furnished by the CRNA. The conversion factor will be for the locality of the performing provider (e.g., physician or CRNA).

When all anesthesia practitioners involved in a procedure are associated in the same group, one practitioner may provide the pre-anesthesia exam and the other practitioner can perform the medical direction and post-anesthesia care. Medical records must indicate the name of the doctor who performed the specific service.


Reimbursement Formulas for Surgical Anesthesia

The formulas for determining payment for surgical procedures requiring anesthesia are as follows:

• Anesthesia performed personally by the anesthesiologist (AA) Base units plus time units times conversion factor = X - 20% = fee.

• Medical direction of 2, 3 or 4 concurrent anesthesia procedures by anesthesiologist (QK) Base units plus time units times conversion factor = X - 50% = Y - 20% = fee.

• Medical direction of one CRNA by an anesthesiologist (QY) Base units plus time units times conversion factor = X - 50% = Y - 20% = fee.

• CRNA service with medical direction by an anesthesiologist (QX) Base units plus time units times conversion factor = X - 50% = Y - 20% = fee.

• Anesthesia performed by the CRNA without medical direction (QZ) Base units plus time units times conversion factor = X - 20% = fee.

• In billing for anesthesia for second and third degree burn excision or debridement with or without skin grafting, report the total anesthesia time with code 01952 and report the appropriate number of units of body surface area with code 01953.

** Reimbursement for code 01952 will be as follows: Base units of 01952 plus time units for CPT 01952 and 01953 (1 = 15 minutes) times conversion factor ($16.41) = X - 20% = fee.

** Reimbursement for code 01953 will be:

One base unit for each unit of 01953 times the conversion factor ($16.41) = X -20% = fee. For 01953 only, report units instead of time in Item 24G.