Guidelines for Qualified Non-Physician Anesthetist Billing

2. Guidelines for Qualified Non-Physician Anesthetist Billing • Certified Registered Nurse Anesthetists (CRNAs) and Anesthesiologists’ Assistants are considered as qualified non-physician anesthetists for purpose of anesthesiology billing. In this article, we shared general billing guidelines and payment for qualified non-physician anesthetist billing. As most insurance carriers adhere to Medicare billing guidelines, we referred Medicare claims processing manual chapter 12. You are advised to refer to payer-specific guidelines for actual reimbursement and appropriate selection of modifiers. Before diving into billing guidelines, let’s understand Medicare’s definition of an Anesthesiologist’s Assistant and Certified Registered Nurse Anesthetists (CRNAs). • Anesthesiologist’s Assistant • An anesthesiologist’s assistant means a person who: • Works under the direction of an anesthesiologist; • Is in compliance with all applicable requirements of State law, including any licensure requirements the state imposes on non-physician anesthetists; and • Is a graduate of a medical school-based anesthesiologist assistant educational program that

3. Guidelines for Qualified Non-Physician Anesthetist Billing • Is accredited by the Committee on Allied Health Education and Accreditation; and • Includes approximately two years of specialized basic science and clinical education in anesthesia at a level that builds on a premedical undergraduate science background. • Certified Registered Nurse Anesthetists (CRNAs) • A CRNA is a registered nurse who: • Is licensed as a registered professional nurse by the State in which the nurse practices; • Meets any licensure requirements the State imposes with respect to non-physician anesthetists; • Has graduated from a nurse anesthesia educational program that meets the standards of the Council on Accreditation of Nurse Anesthesia Programs; and • Meets the following criteria: • Has passed a certification examination of the Council on Certification of Nurse Anesthetists or the Council on Recertification of Nurse Anesthetists; or

4. Guidelines for Qualified Non-Physician Anesthetist Billing • Is a graduate of a nurse anesthesia educational program that meets the standards of the Council of Accreditation of Nurse Anesthesia Educational Programs, and within 24 months of graduation, has passed a certification examination of the Council on Certification of Nurse Anesthetists or the Council on Recertification of Nurse Anesthetists • Guidelines for Qualified Non-Physician Anesthetist Billing • CRNAs and anesthesiologists’ assistants may bill Medicare directly for their services or have payment made to any individual or entity (such as a hospital, critical access hospital, physician, group practice, or ambulatory surgical center) with which the CRNA or anesthesiologist’s assistant has an employment or contractor relationship that provides for payment to be made to the individual or entity. Claims with qualified non-physician anesthetist billing should be completed in accordance with existing billing instructions for anesthesiologists with the following additions: • If an employer-physician furnishes concurrent medical direction for a procedure involving CRNAs and the medical direction service is unassigned, the physician should bill on an assigned basis on a separate claim for the qualified non-physician anesthetist service. If the physician is participating or takes an assignment,

5. Guidelines for Qualified Non-Physician Anesthetist Billing • bothservices should be billed on one claim but as separate line items. • All claims forms must have the provider billing number of the qualified non-physician anesthetist and/or the employer of the qualified non-physician anesthetist performing the service in either block 24.H of the form CMS-1500 and/or block 31 as applicable. Verify that the billing number is valid before making payment. A CRNA is identified on the provider file by specialty code 43. An anesthesiologist’s assistant is identified on the provider file by specialty code 32. • Payment for Qualified Non-physician Anesthetists • Payment for the services furnished by qualified non-physician anesthetists are subject to the usual Part B coinsurance and deductible and are made only on an assignment basis. The assignment agreed to by the qualified non-physician anesthetist is binding upon any other person or entity presenting a claim or request for payment for the service. • The fee schedule for anesthesia services furnished by qualified non-physician anesthetists is the applicable locality-adjusted anesthesia conversion factor multiplied by the sum of allowable base and time units. The anesthesia locality-adjusted conversion factors are updated by the update factor used

6. Guidelines for Qualified Non-Physician Anesthetist Billing • to update physicians’ services under the physician fee schedule. They are generally published in November of the year preceding the year in which they apply. • The allowance for an anesthesia service furnished by a qualified non-physician anesthetist that meets the requirements for payment at the medically directed rate is based on a fixed percentage of the allowance recognized for the anesthesia service personally performed by the physician alone. • The anesthesia locality-adjusted conversion factor for anesthesia services furnished by a CRNA that does not meet the requirements for payment at the medically directed rate may not exceed the allowance for a service personally performed by a physician. • Anesthesia time means the time during which a qualified non-physician anesthetist is present with the patient. It starts when the qualified non-physician anesthetist begins to prepare the patient for anesthesia services in the operating room or an equivalent area and ends when the qualified non-physician anesthetist is no longer furnishing anesthesia services to the patient, that is, when the patient may be placed safely under post-operative care. Anesthesia time is a continuous time period from the start of anesthesia to the end of an anesthesia service. In counting anesthesia time, the qualified non-physician anesthetist can add blocks of time around an interruption in anesthesia time as long as the qualified non-physician anesthetist is furnishing continuous anesthesia care within the time periods around the interruption.

7. Guidelines for Qualified Non-Physician Anesthetist Billing • The following modifiers are used by qualified non-physician anesthetists when billing for anesthesia services: • QX: Qualified non-physician anesthetist service, with medical direction by a physician. • QZ: CRNA service, without medical direction by a physician. • QS: Monitored anesthesia care services. Note that the QS modifier can be used by a physician or a qualified non-physician anesthetist and is for informational purposes. Providers must report actual anesthesia time and one of the payment modifiers on the claim. • Medical Billers and Coders (MBC) is a leading medical billing company providing complete medical billing and coding services. We shared billing Guidelines and payment details for qualified non-physician anesthetist billing for provider education purposes. • For appropriate anesthesiology billing and coding, you are advised to refer to payer-specific billing guidelines and reimbursement policies. If you need any assistance with anesthesiology billing, call us at: 888-357-3226 or email us at: info@medicalbillersandcoders.com. • Reference: Medicare Claims Processing Manual Chapter 12