Anesthesia Fee Calculation
January 29th, 2018 - Find-A-CodeCategories: Anesthesia|Pain Management
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Fees for anesthesia services are not calculated the same as for other types of procedures. There are four elements to consider when calculating anesthesia fees. Medicare accepts base units and time units; however, depending on the third party payer, they may or may not accept physical status units and/or qualifying circumstances units.
- Base Unit (of the CPT code)
- Time (in 15 minute increments)
- Physical Status (P1, P2, P3, P4, P5, P6)
- Qualifying Circumstances (four CPT add-on code options: 99100, 99116, 99135, 99140)
FindACode.com has a fee calculator on the code information page for anesthesia codes, which accounts for Medicare and calculates fees from the base unit and amount of time reported.
Example:
| Base unit for 00820: | 5 |
| Time units for 45 min: 45min/15min = | 3 |
| Physical Status: | N/A |
| Qualifying circumstances: | N/A |
| Conversion factor: | $22.05 |
| 5+3=8 units 8 units X $22.05 = | $176.40 Medicare Allowed |
If the private payer accepts Physical Status (PS) and/or Qualifying Circumstances (QC) as units, these may also be included as part of the fee calculation. Below, the general value of units are shown with each PS Modifier or QC add-on code. Always check the payer policies to see if these rules apply and if the unit values are different:
| PS Modifier: Value | QC Modifiers: Value |
| P1: 0 | 99100: 1 |
| P2: 0 | 99116: 5 |
| P3: 1 | 99135: 5 |
| P4: 2 | 99140: 2 |
| P5: 3 | |
| P6: 0 | |
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