101 CMR, § 316.04 - Maximum Allowable Fees - Anesthesia Services
(1)
Anesthesia
Services. Anesthesia services may include, but are not limited to,
general, regional, supplementation of local anesthesia, or other supportive
services in order to afford the patient the anesthesia care deemed optimal by
the anesthesiologist or CRNA during any procedure. These services include the
usual preoperative and postoperative visits, the anesthesia care during the
procedure, the administration of fluids, and/or blood incident to the
anesthesia or surgery, and the usual monitoring procedures. Unusual forms of
monitoring (e.g., intra arterial, central venous, and Swan
Ganz) are not included.
(2)
Rate Determination. The administration of anesthesia
is reported by the use of the anesthesia five digit procedure code
(00100-01999) listed in
101
CMR 316.05(4)(a) and
modifiers applicable to anesthesia services listed in
101
CMR 316.04(7). Payment for
anesthesia services is determined by a system of base anesthesia units and time
anesthesia units. The total anesthesia reimbursement (the "Total Anesthesia
Fee") is the sum of the number of base anesthesia units multiplied by the base
anesthesia unit fee, plus the number of time anesthesia units multiplied by the
time anesthesia unit fee. Anesthesia time units are measured in minutes and one
time anesthesia unit equals one minute. Payable anesthesia time starts when the
anesthesiologist or CRNA begins to prepare the patient for the induction of
anesthesia in the operating room or in an equivalent area and ends when the
anesthesiologist or CRNA is no longer in personal attendance, that is, when the
patient may be safely placed under postoperative supervision.
(3)
Maximum Unit
Fee. The maximum allowable fee for anesthesia services under 101
CMR 316.00 is $19.90 per base anesthesia unit and $1.33 per one minute time
anesthesia unit.
(4)
Multiple Surgery Procedures. When anesthesia is
administered for multiple surgery procedures, only the base anesthesia units
for the procedure with the largest number of units is used for the base
anesthesia unit portion of the Total Anesthesia Fee calculation.
(5)
Personally Performed
Anesthesia Services. Personally performed anesthesia services are
anesthesia procedures that are personally performed alone by either an
anesthesiologist or a CRNA. For a CRNA, personally performed anesthesia
services are those that a CRNA performs alone without medical direction of an
anesthesiologist. Payment for personally performed anesthesia services of an
anesthesiologist, or for personally performed anesthesia services of a CRNA for
which the governmental unit provides separate payment, may be claimed by
appending the appropriate anesthesia modifier to the anesthesia procedure code.
Payment for personally performed anesthesia services by an anesthesiologist, or
by a CRNA, is 100% of the Total Anesthesia Fee; provided that, if a CRNA is
employed by the facility in which the personally performed anesthesia service
is provided, governmental units may specify other payment rules for the CRNA's
services including, without limitation, specifying that there is no separate
payment for the CRNA's services.
(6)
Medical Direction of CRNA
Anesthesia Services. Payment for an anesthesiologist's medical
direction of a CRNA, or for the services of a CRNA performed with medical
direction of an anesthesiologist for which the governmental unit provides
separate payment, may be claimed by appending the appropriate anesthesia
modifier to the anesthesia procedure code. If an anesthesiologist provides
medical direction of a CRNA, payment for the anesthesiologist's services is 50%
of the Total Anesthesia Fee. Payment for the CRNA's services performed with
medical direction of an anesthesiologist is 50% of the Total Anesthesia Fee;
provided that, if a CRNA is employed by the facility in which the anesthesia
service is performed, governmental units may specify other payment rules for
the CRNA's services including, without limitation, specifying that there is no
separate payment for the CRNA's services.
(7)
Modifiers. For
modifiers and related descriptions applicable to anesthesia services (AA, QK,
QY, QX, and QZ), see
101
CMR 316.05(3).
Notes
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