Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 433.000 - Physician Services › Section 433.454 - Anesthesia Services

Current through Register 1525, July 5, 2024
(A)
Payment
.
(1)
Payment Determination
. The MassHealth agency pays an
			 anesthesiologist or a Certified Registered Nurse Anesthetist (CRNA) for
			 anesthesia services as described in 101 CMR 316.00:
Surgery and
			 Anesthesia
, and 130 CMR 433.454. Payment for anesthesia services is
			 determined using a system of base anesthesia units and time anesthesia
			 units.
(2)
Base
			 Anesthesia Units
. Providers must report the administration of
			 anesthesia on the claim by using the applicable five-digit anesthesia procedure
			 code (00100-01999), and any applicable modifier. The anesthesia procedure code
			 determines the number of base anesthesia units that correspond to the
			 procedure. If a base anesthesia unit is not established for a service, the
			 MassHealth agency pays using time anesthesia units only. When anesthesia is
			 administered for multiple surgery procedures, only the base anesthesia units
			 corresponding to the procedure with the largest number of units is used to
			 determine payment. The number of base anesthesia units does not vary based on
			 the type of anesthesia that is administered.
(3)
Time Anesthesia
			 Units
.
(a)
Payable
			 Anesthesia Time
. Payable anesthesia time starts when the
			 anesthesiologist or CRNA begins to prepare the patient for the induction of
			 anesthesia in the operating room or equivalent area. Payable anesthesia time
			 ends when the patient may be safely placed under postoperative
			 supervision.
(b)
Reporting Time Anesthesia Units
. A provider must
			 report only payable time anesthesia units in the number of units field on the
			 claim. The provider must not include base anesthesia units or units that exceed
			 the criteria set forth in 130 CMR 433.454(A)(3)(a) in the number of units
			 field. Time anesthesia units are measured in minutes. One unit equals one
			 minute.
(4)
Personally Performed Anesthesia Services
. Anesthesia
			 procedures that are personally performed alone by either an anesthesiologist,
			 or a CRNA not employed by the facility in which the anesthesia services are
			 provided, are payable by MassHealth. For a CRNA, personally performed
			 anesthesia services are those that a CRNA performs alone without medical
			 direction of an anesthesiologist. Payment for personally performed anesthesia
			 services may be claimed by appending the appropriate anesthesia modifier to the
			 anesthesia procedure code. If a CRNA is employed by the facility in which the
			 personally performed anesthesia services are provided, there is no separate
			 payment for the CRNA's services. Refer to subchapter 6 of the
Physician
			 Manual
for appropriate modifiers.
(5)
Medical Direction and Medical
			 Supervision
. The MassHealth agency pays for medical direction as
			 described in
			 101 CMR 316.00:
Surgery and Anesthesia
and 130 CMR 433.454(C). Refer to
			 Subchapter 6 of the
Physician Manual
for appropriate
			 modifiers. The MassHealth agency does not pay for medical supervision as
			 further described in 130 CMR 433.454(D).