CSHCN 2008 > Physician > Benefits and Limitations

24.3.3.4 Reimbursement

Reimbursement of anesthesiology services is calculated from total anesthesia time and base units related to the complexity of the procedure. These base units are represented as RVUs. When multiple procedures are performed, the base units represent the procedure with the highest RVUs. The total minutes of anesthesia time is divided by 15 minutes or 30 minutes according to the modifier billed.

The time units are added to the base units, then the sum of all units is multiplied by a conversion factor of $15.55 established for physicians.

The CSHCN Services Program may cover services provided by a certified registered nurse anesthetist (CRNA). CRNAs must be approved by the Texas BON to practice as a CRNA, be enrolled in the Texas Medicaid Program, and have completed a TMHP-CSHCN Services Program Provider Enrollment Application.

Refer to: Chapter 12, "Certified Registered Nurse Anesthetist (CRNA)" for more information on CRNA services.

Procedure codes 1-99100, 1-99116, 1-99135, and 1-99140 are qualifying circumstances that impact the character of the anesthesia services provided. These codes are not payable separately. These codes must be billed with an anesthesia procedure or service.

Reimbursement to freestanding ASCs, or day surgery centers for supplies and medications used in the administration of anesthesia that was provided in conjunction with the surgery is considered part of the inclusive charge.