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Ohio - Anesthesia Billing Clarification - March 5, 2012

posted Mar 21, 2012, 8:18 AM by Compensate Admin

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 $2.83333 = $297.50 reimbursed.

BWC’s system prices at a current rate of $2.83333 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.             

 ***Please note BWC does not recognize the application of CPT© Anesthesia Physical Status Modifiers (P1-P6) for additional reimbursement of anesthesia services. Providers shall not append P1-P6 to the CPT© anesthesia code nor calculate an increased amount of anesthesia time due to the patient’s current physical status.    

Compensate Admin,
Mar 1, 2013, 11:40 AM