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Instruction Paying Anesthesia Fee Bills

posted Apr 24, 2013, 6:07 AM by Compensate Admin   [ updated Apr 24, 2013, 7:12 AM ]
Anesthesia can be billed on CMS form UB04 and is processed the same as any other Inpatient or Outpatient line item by utilizing the Cost To Charge process and its appropriate modifiers of either 11 or 13. 

Anesthesia can also be billed on a CMS form 1500 and the process for paying is a follows:
An anesthesia bill contains two components
    1.    ABU’s or anesthesia base units
    2.    The actual timed minutes used during the procedure.
Note: if time units are not shown on the fee bill, contact the provider

In the case of CPT 00400 in which the actual minutes used was 1 hour

CPT 00400 has Three ABUs (15 minutes per ABU) = 45 minutes
One hour of anesthesia timed service = 60 minutes (one minute per unit)
For a total number of minutes = 105 minutes x The BWC rate of $2.88133 per minute = $302.54 reimbursed.

Fill in the Compensate® CPT payment screen as you would normally up to the point where you would enter the fee bill amount.  

When you enter the fee bill amount a pop up window will appear asking you to enter the beginning and ending time values from the fee bill.  

The time values must be in 24hr clock For example 1:30 in the afternoon is entered as 1330, 12:30am is entered as 1230

The final result is as below and may or may not agree with the fee bill depending on whether or not the provider included the ABU values on the in the bill. 

(see rules section below)

Compensate® calculates the fee bill using the BWC base units table and the timed minutes from the fee bill.

The payer is responsible to determine the final payment amount. (See rules section below)

Rules Section

Anesthesia Billing Clarification

March 5, 2012

With the implementation of the 837 5010 version in the health-care industry, covered entities under the Health Insurance Portability and Accountability Act now must report anesthesia care in one-minute increments as opposed to the previous 15-minute units. The correct way for a provider to submit a bill to BWC is to report the    Medicare anesthesia base unit (ABU) in minutes added to the timed anesthesia services. 

As noted in Chapter 3 of the Billing and Reimbursement Manual, it is the provider’s responsibility to calculate the total number of anesthesia minutes when submitting a CMS 1500 for payment. BWC will use the sum of the minutes of the ABU and the timed care to determine reimbursement.

The bill for anesthesia services must reflect total minutes in the Units column (24G) of the CMS 1500.

EXAMPLE:  Three ABUs (15 minutes per ABU) = 45 minutes + 60 minutes (one hour of anesthesia timed service per one minute per unit) = 105 minutes x $2.83133 = $302.54 reimbursed.

BWC’s system prices at a current rate of $2.83133 per unit for dates of service from Jan. 1, 2012 and beyond.  You can find service reimbursement information in the preamble of the current Professional Provider Medical Services Fee Schedule per the link below. 

Provider e-News October 2012

Anesthesia base units 

Effective Jan. 1, 2013, anesthesia providers will no longer be required to submit the Medicare Designated anesthesia base units (ABUs) in addition to the timed anesthesia service on their Center for Medicare and Medicaid Services (CMS) 1500. 

The ABUs are adopted as part of the Medical Services and Professional Provider Fee Schedule. The managed care organizations will be adding the ABUs to the encounter and submitting that information to BWC for provider anesthesia-care reimbursement. 

For more information, email fee schedule questions to the Medical Services Division.
Compensate Admin,
Apr 24, 2013, 6:07 AM
Compensate Admin,
Apr 24, 2013, 6:07 AM