Billing for Anesthesia Services
Issue: #388 MAY2016
Blue Cross Blue Shield of North Dakota’s (BCBSND) would like to clarify the billing requirements for anesthesia services.
Anesthesia billing information can be found on the BCBSND anesthesia fee schedule. Fee schedules are reviewed and updated each year in July to reflect current reimbursement. All participating (par) providers receive this fee schedule annually.
Here are some other tips for submitting claims for anesthesia services:
- Anesthesia services are submitted on a CMS 1500 claim form.
- Report total anesthesia time as minutes in the units field.
- BCBSND will convert the minutes billed into 15-minute time units. These time units will be added to the procedure’s base units to determine reimbursement.
- BCBSND used the base units as published in the most recent copy of the American Society of Anesthesiologists (ASA) Relative Value Guide.
- Anesthesia services must be submitted according to the descriptive terms and identifying codes used to report medical services and procedures performed as set forth by the American Medical Association (AMA) Current Procedure Terminology (CPT®) and applicable time units.
- The appropriate modifier must be attached to the anesthesia CPT® code indicating who is providing the anesthesia service.
- Reimbursement for CPT® code 01967 (labor epidural) is calculated using set time units of five plus base units multiplied by the appropriate anesthesia conversion factor. This is not a time based code.
- Anesthesia documentation must reflect the correct information in order to support the anesthesia services/codes billed (i.e. provider, start time, stop time, total time, etc.).