Anes 102 - Anesthesia Reimbursement - Medicare Advantage

Anesthesia Reimbursement - Medicare Advantage

Policy No: 102
Date of Origin: 11/01/2013
Section: Anesthesia
Last Reviewed Date: 06/01/2018
Last Revised Date: 09/01/2014
Approved: 06/07/2018
Effective: 07/01/2018

This policy applies only to physicians an other qualified health care professionals.

Definitions

Anesthesia
The administration of a drug or anesthetic agent by an anesthesiologist or Certified Registered Nurse Anesthetist (CRNA) for medical or surgical purposes to obtain muscular relaxation, induce partial or total loss of sensation and/or consciousness.

Base Units
Our health plan uses Centers for Medicare & Medicaid Services (CMS) base units.

Time Units
The time starting when the anesthesiologist or CRNA begins to prepare the patient for anesthesia care in the operating room or equivalent area, and ending when the anesthesiologist or CRNA is no longer in personal attendance, that is, when the patient is safely placed under post-anesthesia supervision.

This time is billed in minutes. The minutes are then divided into increments used in calculating anesthesia reimbursement. Our health plan uses 15 minute increments; 4 units per hour. Increments of less than 15 minutes will not be counted as 1 unit.

Policy statement

The anesthesia codes (00100 – 01999) listed in the current edition of Current Procedural Terminology (CPT) are the only anesthesia codes recognized for reimbursement by our health plan.

Our health plan follows CMS methodology in reimbursing anesthesia services.

References

None

Cross References

None

Disclaimer

Your use of this Reimbursement Policy constitutes your agreement to be bound by and comply with the terms and conditions of the Reimbursement Policy Disclaimer.