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.
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.
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:
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The OIG conducted a study dated June 2019 wherein they indicated that there were approximately $269 million in overpayments for polysomnography services for the period of 2014 through 2015. According to the OIG “These errors occurred because the CMS oversight of polysomnography services was insufficient to ensure that providers complied with Medicare requirements and to prevent payment of claims that didn’t meet those requirements.”
So what are those requirements?
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