Billing for anesthesia

Here are Priority Health's practices in paying for anesthesia services. The types of anesthesia that these guidelines cover are: General, inhalation, regional, peripheral block, spinal, epidural, IV regional block, field block, and local.

Priority Health does not allow separate payment for the anesthesia service performed by the physician who also furnishes the medical or surgical service, since the anesthesia service is included in the payment for the medical or surgical service.

Go to Anesthesia modifiers list
Go to Moderate (conscious) anesthesia page


Jump down this page to:

• Base units and time units
• Reporting anesthesia time units
• Global fees
• PriorityMedicare requirements

Base units and time units

Base unit values have been assigned to anesthesia CPT codes by the American Society of Anesthesiologists (ASA). We determine payment for most anesthesia services by both the CPT code base value and the time the service takes (time units).

Reporting anesthesia time units

You must report units on the claim line item (example: 1/2 hour = report two units). The actual time should also be reported on the claim in box 19. (Example: "Service began at 11:30 a.m. and ended at 1:25 p.m.")

• 1 unit = 15 minutes
• Reporting begins: When induction is initiated, generally within a few minutes of the initiation of the operative session
  
• Reporting ends: When the patient is transferred to the recovery room and the provider is no longer in personal attendance

Global fees

Certain procedures are reimbursed based on a global fee rather than base value and time units, including (but not limited to):

• Usual preoperative and postoperative visits
• Administration of fluids
• Anesthesia care during the procedure
• Local anesthesia during surgery
• Monitoring of electrocardiograms (EKGs), pulse, breathing, blood pressure, electroencephalograms, and other neurological monitoring
  
• Procedures (example: arterial line insertion)
• Monitoring of left ventricular or valve function via transesophageal echocardiogram
• Monitoring of intravascular fluids (IVs), blood administration and fluids used during cold cardioplegia through non-invasive means
• Maintenance of open airway and ventilatory measurements and monitoring.
  

Priority Health Medicare plan requirements

Providers under contract for Priority Health branded Medicare products will be paid according to the contract. These providers should bill according to Medicare rules; general Medicare payment rules apply.

Providers not under contract with Priority Health Medicare Advantage products will be paid as follows:

• According to Medicare payment schedules for the geographic area in which the provider practices
• According to CMS coverage determinations for anesthesia