Home Administrative Billing & Reimbursement BlueCard® Health and Wellness Medical PEAR portal Pharmacy Products Quality Management

Reminder of billing requirements for anesthesia services

February 8, 2017

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

Independence 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

*Additional reimbursement is not given for modifying units for Medicare Advantage claims.

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.

Do not report base units with an anesthesia procedure code, since Independence calculates the reimbursement using the anesthesia base units from the Centers for Medicare & Medicaid Services.

For more information

To read more about billing for anesthesia services, refer to the following policies:

  • Commercial: #00.01.14o: Reporting and Documentation Requirements for Anesthesia Services
  • Medicare Advantage: #MA00.009d: Reporting and Documentation Requirements for Anesthesia Services

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


This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
Connect with us     Facebook     Twitter     Flickr     YouTube     Walk the Talk    Independence Pinterest    Independence LinkedIn    Independence Instagram Site Map        Anti-Fraud        Privacy Policy        Legal        Disclaimer
© 2023 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.