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
Know Anesthesia billing claim guidelines and rules for getting payments. How to bill the anesthesia claim in the correct manner without time delay. Medicare Anesthesia billing and coding. procedure code list , procedure codes.
Friday, August 6, 2010
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