Thursday, April 28, 2011

payment rules for anesthesia billing

Payment Rules

The fee schedule allowance for anesthesia services is based on a calculation that includes the anesthesia base units assigned to each anesthesia code, the anesthesia time involved, and appropriate area conversion factor. The following formulas are used to determine payment:

• Participating Physician not Medically Directing (Modifier AA)
(Base Units + Time Units) x Participating Conversion Factor = Allowance


• Non-Participating Physician not Medically Directing (Modifier AA)
(Base Units + Time Units) x Non-Participating Conversion Factor=Allowance


• Participating Physician Medically Directing (Modifier QY, QK)
(Base Units + Time Units) x Participating Conversion Factor = Allowance x 50%

• Non-Participating Physician Medically Directing (Modifier QY, QK)
(Base Units + Time Units) x Non-Participating Conversion Factor = Allowance x 50%

• Non-Medically Directed CRNA (Modifier QZ)
(Base Units + Time Units) x Participating Conversion Factor = Allowance

• CRNA Medically Directed (Modifier QX)
(Base Units + Time Units) x Participating Conversion Factor = Allowance x 50%

1 comment:

  1. Claims for anesthesia services submitted by the provider who performs the surgical procedure are denied as included in the global rate for the procedure. The member is not responsible for these charges. This does not pertain to oral surgeons or dentists... Laboratory Coding

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