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PAP500

Anesthesia - How to Bill for Time


Provider Administrative Policy

Section
Physician
Policy Date
November 2007
Status/Date
Revised/December 2012
Provider Type(s)
Ambulatory Surgery Centers   Hospitals   Physician   Podiatrists  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Anesthesia - How to Bill for Time

Blue Cross of Idaho allows reimbursement on anesthesia services when provided by an Anesthesiologist, Certified Registered Nurse Anesthetist (CRNA) or a Pediatric Critical Care Physician.  Blue Cross of Idaho does not recognize Dentists and Oral Surgeons as authorized anesthesia providers.

Blue Cross of Idaho calculates anesthesia reimbursements using the following equation:

Reimbursement = unit allowance (base units + time units) x conversion factor rate.

 One time unit is equal to a 15-minute increment.

Anesthesia claims submitted to Blue Cross of Idaho must include the total minutes. When submitting a paper claim, report the minutes in field 24G on the CMS 1500 form. For electronic claims, place the minutes in the appropriate field. Blue Cross of Idaho will automatically include the base units in its calculations. Do not include base units as part of the time units you submit.

Qualifying Circumstances
When submitting claims with qualifying circumstances, Blue Cross of Idaho pricing is set to calculate the allowance for one unit multiplied against the unit values listed below.  Therefore, qualifying circumstance codes should be submitted with just one unit.

 Code

Units

 99100

   1

 99116

   5

 99135

   5


There is no allowance for 99140 and it is considered a contractual adjustment for traditional, PPO and commercial managed care contracts. If you feel this is an emergent situation, please continue to enclose related medical records for review. If after record review it is determined to be allowed, an additional 2 units will be assigned to the base anesthesia code. Please refer to PAP229 and PAP235 for additional information.

For Hospitals
Use a CMS 1500 form and follow the instructions above when submitting anesthesia claims for a hospital-based anesthesiologist.


Policy History

Date Action Reason
December 2012 Revised Language revision
November 2010 Revised Allowance change
May 2008 Revised Language clarification

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