Anesthesia Billing for CRNAs

When filing claims through the Medicare program and the CRNA is employed by the anesthesiologists, reimbursement for “medically directed” by an anesthesiologist and “non-medically directed” are revenue neutral - meaning reimbursement is equal to the same amount.  

For example, when medical direction modifiers “QK and QX” are reported (see table below), reimbursement is divided equally (50% and 50%) between the physician and the CRNA.  When a CRNA is non-medically directed, full reimbursement (100%) is paid. It is a misconception that an MD/CRNA care team must report Medicare modifiers to all insurance companies, and doing so may cause reimbursement problems.  

Not all carriers recognize separate claims or Healthcare Common Procedure Coding System (HCPCS) modifiers!  

Many private insurers expect CRNA services to be billed under the anesthesiologist, on one line of the claim form. Reporting separately may result in a claim denial or improper payment.  An additional confusion, since many practices generally equally split the full amount of the bill between the physician and CRNA, is that the claim is viewed as a duplicate.  

Although Medicare pays the CRNA and anesthesiologist equal shares, other carriers may not pay the separate charge, leaving your patient with a large out-of-pocket expense.

One way to avoid confusion when you must bill two claims, i.e. to collect a Medicare secondary balance, is to charge different amounts for the physician and CRNA.  

For example, in our practice we assigned 70% of the conversion factor to the physician and 30% to the CRNA; however, your practice may choose to assign a different value.    

Assigning different values when claims must be split helps identify and separate the services of the physician and the CRNA, as well as decrease odds the claims will be mistaken as duplicate.  It is important to remember, however, not to assign a CRNA value so low that the submitted charge is less than the allowed or expected amount!

How can you tell when to send separate claims?  

One clue is to determine whether a separate provider number is needed, such as Tricare, which does credential CRNAs. To receive payment from carriers that require two claims, the CRNA must have a valid provider number and have reassigned their benefits.  It is important to ensure the provider number is valid before the CRNA begins working.  

Many practices lose revenue by their inability to bill certain insurances, such as Medicare and Medicaid, for a CRNA whose number is not yet in place, such as temporary providers.  Although short-term contract or temporary CRNAs are called “locum tenens,” the locum tenens modifier is not intended to be used to bill for their services.

In most instances, CRNAs are prohibited from using the Q6 modifier to receive payment, since by definition the modifier indicates the service was provided by a “physician.” However, as to be expected in the anesthesia world of billing, there are no “absolutes”! Georgia Medicare published policy in September of 1999, which specifically allows use of the Q6 modifier by CRNAs. 

Keep in mind, though that without written permission this is generally not an acceptable use of the Q6 modifier.

base units of Anesthesia cpt code - list 2

CPT CODES and BASE UNITS

CPT CODES and BASE UNITS

00930 4 00932 4 00934 6 00936 8 00938 4 00940 3 00942 4 00944 6 00948 4 00950 5 00952 4 01112 5 01120 6 01130 3 01140 15 01150 10 01160 4 01170 8 01173 12 01180 3 01190 4 01200 4 01202 4 01210 6 01212 10 01214 8 01215 10 01220 4 01230 6 01232 5 01234 8 01250 4 01260 3 01270 8 01272 4 01274 6 01320 4 01340 4 01360 5 01380 3 01382 3 01390 3 01392 4 01400 4 01402 7 01404 5 01420 3 01430 3 01432 6 01440 8 01442 8 01444 8 01462 3 01464 3 01470 3 01472 5 01474 5 01480 3 01482 4 01484 4 01486 7 01490 3 01500 8 01502 6 01520 3 01522 5 01610 5 01620 4 01622 4 01630 5 01634 9 01636 15 01638 10 01650 6 01652 10 01654 8 01656 10 01670 4 01680 3 01682 4 01710 3 01712 5 01714 5 01716 5 01730 3 01732 3 01740 4 01742 5 01744 5 01756 6 01758 5 01760 7 01770 6 01772 6 01780 3 01782 4 01810 3 01820 3 01829 3 01830 3 01832 6 01840 6 01842 6 01844 6 01850 3 01852 4 01860 3 01916 5 01920 7 01922 7 01924 6 01925 8 01926 10 01930 5 01931 7 01932 7 01933 8 01935 5 01936 5 01951 3 01952 5 + 01953 1 01958 5 01960 5 01961 7 01962 8 01963 10 01965 4 01966 4 01969 5 01990 7 01991 3 01992 5

00100 5 00102 6 00103 5 00104 4 00120 5 00124 4 00126 4 00140 5 00142 6 00144 6 00145 6 00147 6 00148 4 00160 5 00162 7 00164 4 00170 5 00172 6 00174 6 00176 7 00190 5 00192 7 00210 11 00211 10 00212 5 00214 9 00215 9 00216 15 00218 13 00220 10 00222 6 00300 5 00320 6 00322 3 00326 8 00350 10 00352 5 00400 3 00402 5 00404 5 00406 13 00410 4 00450 5 00452 6 00454 3 00470 6  00472 10 00474 13 00500 15 00520 6 00522 4 00524 4 00528 8 00529 11 00530 4 00532 4 00534 7 00537 10 00539 18 00540 12 00541 15 00542 15 00546 15 00548 17 00550 10 00560 15 00561 25 00562 20 00563 25 00567 18 00566 25 00580 20 00600 10 00604 13 00620 10 00622 13 00625 13 00626 15 00630 8 00632 7 00634 10 00635 4 00640 3 00670 13 00700 4 00702 4 00730 5 00740 5 00750 4 00752 6 00754 7 00756 7 00770 15 00790 7 00792 13 00794 8 00796 30 00797 11 00800 4 00802 5 00810 5 00820 5 00830 4 00832 6 00834 5 00836 6 00840 6 00842 4 00844 7 00846 8 00848 8 00851 6 00860 6 00862 7 00864 8 00865 7 00866 10 00868 10 00870 5 00872 7 00873 5 00880 15 00882 10 00902 5 00904 7 00906 4 00908 6 00910 3 00912 5 00914 5 00916 5 00918 5 00920 3 00921 3 00922 6 00924 4 00926 4 00928 6