As previously communicated, anesthesia time units must be reported in minutes unless otherwise noted. The units are divided by 15 minutes and rounded to one decimal place (e.g., 16 minutes = 1.1 units). If the provider?s anesthesia service is interrupted for a short duration, the total number of minutes should be reported, less the number of minutes representing the interruption.

Note: Anesthesia claims processed prior to July 1, 2011, were rounded to the next whole number (e.g., 16 minutes = 2 units).

Determining reimbursement for eligible anesthesia services

AmeriHealth applies the following standard formula to determine reimbursement for eligible anesthesia services reported in minutes:

• Reported anesthesia time units ? 15 minutes (round the time units to one decimal place) = Time unit
• Time unit + base unit + modifying unit (if applicable) x conversion factor = Reimbursement

If services are billed with a modifier, the reimbursement is remitted as applicable:

• For service(s) billed with modifier AD, QK, QX, or QY, reimbursement is 50 percent of the calculated allowance.
• For service(s) billed with modifier AA or QZ, reimbursement is 100 percent of the calculated allowance.

For more information

To read more about billing for anesthesia services, refer to Claim Payment Policy #00.01.14o: Reporting and Documentation Requirements for Anesthesia Services.

To view this policy, visit our Medical Policy Portal and select Accept and Go to Medical Policy Online. Then select Commercial and type the policy name or number in the Search field.