Anesthesia Reimbursement - Medicare Advantage
Policy No: 102
Date of Origin: 11/01/2013
Last Reviewed Date: 06/01/2018
Last Revised Date: 09/01/2014
This policy applies only to physicians an other qualified health care professionals.
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.
Our health plan uses Centers for Medicare & Medicaid Services (CMS) base 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.
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.