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3.4.2 Reimbursement
A CRNA is reimbursed the lesser of either the CRNA's billed charges or 92 percent of the reimbursement for the same service paid to a physician (MD or DO) anesthesiologist in accordance with 1 TAC §355.8221.
Reimbursement for anesthesia services is determined by a calculation using the relative value units (RVUs) for a particular anesthesia procedure (Base Units) plus the quantity billed (anesthesia Time Units divided by 15) multiplied by the Texas Medicaid Reimbursement Methodology (TMRM) conversion factor for physicians. The formula is Base Unit + Time Units x TMRM.
The formula to calculate anesthesia reimbursement can be found in the cover letter section of the CRNA Fee Schedule. The formula includes base units, time units, and a conversion factor.
A base unit represents the level of intensity for anesthesia procedure services that reflects all activities except time. These activities include usual preoperative and post-operative visits, the administration of fluids and/or blood incident to anesthesia care, and monitoring procedures.
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