As previously communicated, anesthesia time units must be reported in
minutes unless otherwise noted. The units are divided by 15 minutes and rounded
to one decimal place (e.g., 16 minutes = 1.1 units). If the provider?s
anesthesia service is interrupted for a short duration, the total number of
minutes should be reported, less the number of minutes representing the
interruption.
Note: Anesthesia claims processed prior to July 1, 2011, were
rounded to the next whole number (e.g., 16 minutes = 2 units).
Determining reimbursement for eligible
anesthesia services
Independence applies the following standard formula to determine
reimbursement for eligible anesthesia services reported in minutes*:
- Reported anesthesia time units ? 15 minutes (round the time units to one
decimal place) =
Time unit
- Time unit + base unit + modifying unit (if applicable) x conversion factor
= Reimbursement
*Additional reimbursement is not given for modifying
units for Medicare Advantage claims.
If services are billed with a modifier, the reimbursement is remitted as
applicable:
- For service(s) billed with modifier AD, QK, QX, or QY, reimbursement is 50
percent of the calculated allowance.
- For service(s) billed with modifier AA or QZ, reimbursement is 100 percent
of the calculated allowance.
Do not report base units with an anesthesia procedure code, since
Independence calculates the reimbursement using the anesthesia base units from
the Centers for Medicare & Medicaid Services.
For more information
To read more about billing for anesthesia services, refer to the following
policies:
- Commercial: #00.01.14o: Reporting and Documentation
Requirements for Anesthesia Services
- Medicare Advantage: #MA00.009d: Reporting and
Documentation Requirements for Anesthesia Services
To view these policies, visit our Medical Policy Portal and
select Accept and Go to Medical Policy Online. Then select
Commercial or Medicare Advantage and type the policy name or
number in the Search field.