Anesthesia services

Applies to:

Commercial and Medicaid plans

Also see Medicare anesthesia billing, below

Definition

These guidelines cover general, inhalation, regional, peripheral block, spinal, epidural, IV regional block, field block, and local anesthesia services.

Anesthesia services billing

Payable:

When reported with either base units and time units or with global fees (see below)

Not payable:

Separate payment for the anesthesia service performed by the physician who also furnishes the medical or surgical service, since the anesthesia service is included in the payment for the medical or surgical service. See the anesthesia modifiers list.

Purchase of durable medical equipment when it is needed to perform procedures reimbursed under global fees

Preventive services, professional and facility claims

Colonoscopy with anesthesia: Not covered as preventive if you bill only the 0370 revenue code.

2018 dates of service: Report code 00812 with revenue code 0370 to make sure the claim processes as preventive. The PT or 33 modifier is no longer needed when a screening colonoscopy becomes diagnostic.

Female sterilization: If sterilization is the only reason for the encounter, report CPT code 00581 or 00952 for anesthesia.

CRNA billing

Certified Registered Nurse Anesthetists (CRNAs) are reimbursed on a 50% split with the supervising anesthesiologist. See the HCPCS Level II modifiers list for more.

Base units and time units

Base unit values have been assigned to anesthesia CPT codes by the American Society of Anesthesiologists (ASA). We determine payment for most anesthesia services by both the CPT code base value and the time the service takes. Time units are measured in 15-minute increments.

Reporting anesthesia time units

You must report units on the claim line item (example: 1/2 hour = report two units). The actual time should also be reported on the claim in box 19. (Example: "Service began at 11:30 a.m. and ended at 1:25 p.m.")

  • Reporting begins: When induction is initiated, generally within a few minutes of the initiation of the operative session
  • Reporting ends: When the patient is transferred to the recovery room and the provider is no longer in personal attendance

Anesthesia services reimbursed based on global fees

Certain procedures are reimbursed based on a global fee rather than base value and time units, including (but not limited to):

  • Usual preoperative and postoperative visits
  • Administration of fluids
  • Anesthesia care during the procedure
  • Local anesthesia during surgery
  • Monitoring of electrocardiograms (EKGs), pulse, breathing, blood pressure, electroencephalograms, and other neurological monitoring
  • Procedures (example: arterial line insertion)
  • Monitoring of left ventricular or valve function via transesophageal echocardiogram
  • Monitoring of intravascular fluids (IVs), blood administration and fluids used during cold cardioplegia through non-invasive means
  • Maintenance of open airway and ventilatory measurements and monitoring.

Priority Health Medicare anesthesia billing

Providers under contract for Priority Health branded Medicare products will be paid according to the contract. These providers should bill according to Medicare rules; general Medicare payment rules apply.

Providers not under contract with Priority Health Medicare Advantage products will be paid according to Medicare payment schedules for the geographic area in which the provider practices.