Anesthesia
Price an anesthesia claim
Anesthesia lines are priced on the professional claim pricer: enter the anesthesia code, its modifier and the minutes, and see the base units, time units, conversion factor and medical direction share behind the allowed amount.
How Medicare pays anesthesia
The allowed amount is the procedure's base units plus one time unit for every 15 minutes of anesthesia time, times the anesthesia conversion factor for the locality the service ZIP falls in. On the claim line, Units are the minutes of anesthesia time, not a count of services.
| Modifier | Who and how | Share of the fee |
|---|---|---|
| AA | Anesthesiologist personally performing the case | Full fee |
| QZ | Nurse anesthetist (CRNA) without medical direction | Full fee |
| QK | Anesthesiologist medically directing two to four concurrent cases | Half |
| QY | Anesthesiologist medically directing one CRNA | Half |
| QX | CRNA with medical direction by a physician | Half |
A worked case
The sample case is 00790 (anesthesia for upper abdominal laparoscopy) with modifier QK, 141 minutes, in an inpatient hospital (place of service 21) in Houston, ZIP 77030. Open it to see each step, then change the code, minutes, modifier or ZIP.
Tips
- Set the practitioner type to Nurse anesthetist when a CRNA bills under their own NPI.
- A nerve block or line placed by the anesthesia provider is billed on its own line with its own code.
- Texas and Virginia Medicaid anesthesia fees, which use each state's own conversion factor, are on the Medicaid pricer.
- Do not enter patient names, member IDs or other patient identifiers: codes, dates and amounts are all the pricer needs.