By: Hal Nelson, CANPC
Vice President, Anesthesiology Services
MSN Healthcare Solutions
Payment Calculations for Anesthesia Services
Payment for anesthesia services is calculated by insurance plans using a formula of:
“Base Units x Time Units”, multiplied by the payor’s Conversion Factor.
Base units include the standard pre-operative and post-operative visits, administration of fluids and blood products incident to the anesthesia care and interpretation of non-invasive physiological monitoring. Essentially, these units describe the complexity of the surgery and are valued from 3 to 30, depending upon the procedure.
While you’d think they would be the same for all insurance companies, they’re not. Eight codes in particular, are valued less by CMS than the ASA Relative Value Guide. There are also some commercial/managed care plans which use the lower-valued CMS base units.
To ensure that your future revenue projections are accurate, we recommend using the attached list and confirming the base unit methodology which your main payors utilize.
Hal has 30+ years of experience on both the payor and RCM side, with a focus in Anesthesia. He formerly worked as a senior claims approver at United Healthcare, as well as a compliance officer for multiple national anesthesia billing companies. His broad-based experience ensures that MSN clients have a resource for documentation and billing issues. His past speaking engagements include ASA, MGMA, Dartmouth, and Johns Hopkins.
