For the purpose of billing time units, the following definition is used:
"Anesthesia time begins when the anesthesiologist begins to prepare the patient for the induction of anesthesia in the operating room or in an equivalent area and ends when the anesthesiologist is no longer in personal attendance, that is, when the patient may be safely placed under post-operative supervision."
The time indicated on the claim in minutes is divided by 15- or 30-minute increments based on the indicated modifier. This determines the time units that are used in the payment formula. The total time unit amount for the modifier AD is one (1). A modifier must be used on all claims.
Modifier
Description
Time Divided by 15 Minutes
Percent Reductions of Base Units
QX
CRNA medically directed
N/A
N/A
AA
Anesthesia services performed personally by anesthesiologist
15 minutes
0 percent
AD
Medical supervision by a physician
Total time unites for claims will be one
0 percent
QK
Medically direction of two, three, or four concurrent procedures involving qualified individuals
30 minutes
10 percent
QZ
CRNA service without medical direction by a physician
N/A
N/A
QY
Medical direction of one certified registered nurse
N/A
N/A
Total units (as determined by the above guidelines) are multiplied by the conversion factor of $15.55.
The Billed Qty (quantity) field on the R&S report reflects only the number of units TMHP processed for time. The RVUs assigned for the procedure code are not reflected in the Billed Qty field, but can be determined by subtracting the units allowed for time from the total units paid.
Texas Medicaid & Healthcare Partnership CPT only copyright 2007 American Medical Association. All rights reserved.
