Friday, August 6, 2010

Anesthesia payment reimbursement examples

REIMBURSEMENT EXAMPLES

(Time Units + Base Units) x Conversion Factor = Allowance

Texas Example 1
(This is an example only. Providers should check their current anesthesia conversion factors for correct fee amounts.)
Rev. 01/2010 24 Reimbursement Examples
Code: 00830
Time: 120 minutes
Locality: Rest of state (participating physician)
Time: 120/15 = 8 units
Code: 00830 = 4 units
12 units
Conversion factor $19.84
Total units = 12 x $19.84 = $238.08
The physician’s allowed amount would be $238.80. The physician reimbursement is calculated at 80 percent of the allowed amount.

Example 2
Code: 00830
Time: 120 minutes
Locality: Rest of state (non-par physician and medically directed CRNA)
Time: 120/15 = 8 units
Code: 00830 = 4 units
12 units
Conversion factor $18.85 (non-participating)
Conversion factor $18.85 @ 50% = $9.425
Total units = 12 x $9.425 = $113.10
Conversion factor $19.84 (CRNA)
Conversion factor $19.84 @ 50% = $9.92
Total units = 12 x $9.92 = $119.04

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