Maximum Allowable Fees - Anesthesia Services

(1) Anesthesia Services. Anesthesia services may include but are not limited to general, regional, supplementation of local anesthesia, or other supportive services in order to afford the patient the anesthesia care deemed optimal by the anesthesiologist or CRNA during any procedure. These services include the usual preoperative and postoperative visits, the anesthesia care during the procedure, the administration of fluids, and/or blood incident to the anesthesia or surgery, and the usual monitoring procedures. Unusual forms of monitoring (e.g., intra-arterial, central venous, and Swan-Ganz) are not included. (2) Rate Determination. The administration of anesthesia is reported by the use of the anesthesia five-digit procedure code (00100-01999) listed in 101 CMR 316.05(4)(a) and modifiers applicable to anesthesia services listed in 101 CMR 316.04(7). Payment for anesthesia services is determined by a system of base anesthesia units and time anesthesia units. The total anesthesia reimbursement (the “Total Anesthesia Fee”) is the sum of the number of base anesthesia units multiplied by the base anesthesia unit fee, plus the number of time anesthesia units multiplied by the time anesthesia unit fee. Anesthesia time units are measured in minutes and one time anesthesia unit equals one minute. Payable anesthesia time starts when the anesthesiologist or CRNA begins to prepare the patient for the induction of anesthesia in the operating room or in an equivalent area and ends when the anesthesiologist or CRNA is no longer in personal attendance, that is, when the patient may be safely placed under postoperative supervision. (3) Maximum Unit Fee. The maximum allowable fee for anesthesia services under 101 CMR 316.00 is $19.90 per base anesthesia unit and $1.33 per one minute time anesthesia unit. (4) Multiple Surgery Procedures. When anesthesia is administered for multiple surgery procedures, only the base anesthesia units for the procedure with the largest number of units is used for the base anesthesia unit portion of the Total Anesthesia Fee calculation. (5) Personally Performed Anesthesia Services. Personally performed anesthesia services are anesthesia procedures that are personally performed alone by either an anesthesiologist or a CRNA. For a CRNA, personally performed anesthesia services are those that a CRNA performs alone without medical direction of an anesthesiologist. Payment for personally performed anesthesia services of an anesthesiologist, or for personally performed anesthesia services of a CRNA for which the governmental unit provides separate payment, may be claimed by appending the appropriate anesthesia modifier to the anesthesia procedure code. Payment for personally performed anesthesia services by an anesthesiologist, or by a CRNA, is 100% of the Total Anesthesia Fee; provided that, if a CRNA is employed by the facility in which the personally performed anesthesia service is provided, governmental units may specify other payment rules for the CRNA’s services, including, without limitation, specifying that there is no separate payment for the CRNA’s services. (6) Medical Direction of CRNA Anesthesia Services. Payment for an anesthesiologist’s medical direction of a CRNA, or for the services of a CRNA performed with medical direction of an anesthesiologist for which the governmental unit provides separate payment, may be claimed by appending the appropriate anesthesia modifier to the anesthesia procedure code. If an anesthesiologist provides medical direction of a CRNA, payment for the anesthesiologist’s services is 50% of the Total Anesthesia Fee. Payment for the CRNA’s services performed with medical direction of an anesthesiologist is 50% of the Total Anesthesia Fee; provided that, if a CRNA is employed by the facility in which the anesthesia service is performed, governmental units may specify other payment rules for the CRNA’s services, including, without limitation, specifying that there is no separate payment for the CRNA’s services. (7) Modifiers. For modifiers and related descriptions applicable to anesthesia services (AA, QK, QY, QX, and QZ), see 101 CMR 316.05(3).