TMPPM 2010 > Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook > Physician > Procedures and Services > Anesthesia > Reimbursement Methodology

6.3.4.9 Reimbursement Methodology

There are two types of reimbursement for anesthesia procedure codes.

•Flat fee

•Time-based fees, which require documentation of the exact amount of face-to-face time with the client

The anesthesiologist's reimbursement for medical direction of CRNAs and non-CRNA qualified professionals is 100 percent of the maximum allowable fee.

If multiple CRNAs or anesthesiologists are providing anesthesia services for a client, only one CRNA and one anesthesiologist may be reimbursed.

Both the flat-fee and time-based-fee procedure codes must be submitted with modifiers and are subject to medical direction/supervision reimbursement adjustments.

Flat Fees

Both OB related anesthesia procedure codes 01960 and 01967 are considered for reimbursement with a flat-fee rate.

•Flat fees are subject to medically directed modifier combination adjustments based on the modifier submitted with the anesthesia procedure code.

•The time-based add-on procedure code 01968 must be billed in addition to the flat fee when anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia has occurred.

For flat-fee anesthesiology codes, anesthesia time begins when the anesthesia practitioner begins to prepare the client for the induction of anesthesia in the operating room or the equivalent area and ends when the anesthesia practitioner is no longer in personal attendance, that is, when the client may be safely placed under postoperative supervision.

Time-Based Fees

Reimbursement of time-based anesthesia services is derived by adding the relative value units (RVUs) (e.g., base units) for the procedures performed (when multiple procedures are performed use the procedure with the highest RVUs) to the total face-to-face anesthesia time in minutes divided by 15 minutes, multiplied by the appropriate conversion factor, and then by the appropriate modifier combination adjustment:

[RVUs + (Minutes / 15] x Conversion Factor x Modifier Combination Adjustment = Anesthesia Reimbursement

Refer to: Subsection 6.6.3.1, "Anesthesia Reimbursement" in this handbook for additional information about time-based fees.

Conversion Factor

A conversion factor is the multiplier that transforms relative values into payment amounts. There is a standard conversion factor for anesthesia services.