Reimbursement for anesthesia services is determined by a calculation using the RVUs for a particular anesthesia procedure (Base Units) plus the quantity billed (anesthesia Time Units divided by 15) multiplied by the TMRM conversion factor for physicians. The formula is Base Unit + Time Units x TMRM. The following is an example of physician pricing:
Provider Type Description-Physician Pricing Example
Modifier
=
120/15
=
8 (quantity billed)
Procedure Code
=
7-00851 (6 RVUs) 6.00 + 8
=
14.00
Time
=
14.00 x 18.21
=
$254.94 (physician reimbursement)
Texas Medicaid & Healthcare Partnership CPT only copyright 2007 American Medical Association. All rights reserved.
