R 418.101007 Reimbursement for anesthesia services.

Rule 1007. (1) The carrier shall determine the maximum allowable payment for anesthesia services by adding the base units to the time units. The carrier shall reimburse anesthesia services at either the maximum allowable payment, or the practitioner's usual and customary charge, whichever is less. Each anesthesia base unit shall be multiplied by $42.00 to determine payment for the base procedure. (2) Anesthesia base units shall only be paid to an anesthesiologist, a surgeon who provides the anesthesia and performs the surgery, or a certified registered nurse anesthetist providing anesthesia without medical direction of the anesthesiologist. Only 1 practitioner shall be reimbursed for base units, documented by the anesthesia record. (3) The carrier shall reimburse the time units by the total minutes listed in the "days" or "units" column and the alpha modifier added to the procedure code. Time units are reimbursed in the following manner: (a) Increments of 15 minutes or portions thereof, for administration of the anesthesia. (b) Increments of 30 minutes or portions thereof, for supervision or direction of a CRNA or certified anesthesiologist assistant. (c) In no instance shall less than 1 time unit be reimbursed. (4) The maximum allowable payment for anesthesia time shall be calculated in the following manner: (a) If the anesthesiologist administers the anesthesia, then the modifier shall be -AA and the maximum payment shall be $2.80 per minute. (b) If the anesthesiologist provides medical supervision for more than 4 concurrent anesthesia procedures, then the modifier shall be AD and the maximum payment shall be 3 base units. One time unit shall also be paid if the anesthesiologist is present for induction of anesthesia services at $1.40 per minute. (c) If the anesthesiologist provides medical direction to a CRNA or certified anesthesiologist assistant, then the modifier shall be QK and the maximum payment shall be $1.40 per minute. (d) If a CRNA or a certified anesthesiologist assistant administers the anesthesia under the medical direction of an anesthesiologist, then the modifier shall be -QX and the maximum payment shall be $2.80 per minute. (e) If a CRNA administers anesthesia without medical direction of the anesthesiologist, then the modifier shall be -QZ and the maximum payment shall be $2.80 per minute.