Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 316.00 - Rates for surgery and anesthesia services › Section 316.04 - Maximum Allowable Fees - Anesthesia Services

Current through Register 1525, July 5, 2024
(1)
Anesthesia Services
. Anesthesia services may include,
			 but are not limited to, general, regional, supplementation of local anesthesia,
			 or other supportive services in order to afford the patient the anesthesia care
			 deemed optimal by the anesthesiologist or CRNA during any procedure. These
			 services include the usual preoperative and postoperative visits, the
			 anesthesia care during the procedure, the administration of fluids, and/or
			 blood incident to the anesthesia or surgery, and the usual monitoring
			 procedures. Unusual forms of monitoring (
e.g
., intra arterial,
			 central venous, and Swan Ganz) are not included.
(2)
Rate
			 Determination
. The administration of anesthesia is reported by the
			 use of the anesthesia five digit procedure code (00100-01999) listed in
			 101
			 CMR 316.05(4)(a)  and
			 modifiers applicable to anesthesia services listed in
			 101
			 CMR 316.04(7). Payment for
			 anesthesia services is determined by a system of base anesthesia units and time
			 anesthesia units. The total anesthesia reimbursement (the "Total Anesthesia
			 Fee") is the sum of the number of base anesthesia units multiplied by the base
			 anesthesia unit fee, plus the number of time anesthesia units multiplied by the
			 time anesthesia unit fee. Anesthesia time units are measured in minutes and one
			 time anesthesia unit equals one minute. Payable anesthesia time starts when the
			 anesthesiologist or CRNA begins to prepare the patient for the induction of
			 anesthesia in the operating room or in an equivalent area and ends when the
			 anesthesiologist or CRNA is no longer in personal attendance, that is, when the
			 patient may be safely placed under postoperative supervision.
(3)
Maximum Unit
			 Fee
. The maximum allowable fee for anesthesia services under 101
			 CMR 316.00 is $19.90 per base anesthesia unit and $1.33 per one minute time
			 anesthesia unit.
(4)
Multiple Surgery Procedures
. When anesthesia is
			 administered for multiple surgery procedures, only the base anesthesia units
			 for the procedure with the largest number of units is used for the base
			 anesthesia unit portion of the Total Anesthesia Fee calculation.
(5)
Personally Performed
			 Anesthesia Services
. Personally performed anesthesia services are
			 anesthesia procedures that are personally performed alone by either an
			 anesthesiologist or a CRNA. 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 of an
			 anesthesiologist, or for personally performed anesthesia services of a CRNA for
			 which the governmental unit provides separate payment, may be claimed by
			 appending the appropriate anesthesia modifier to the anesthesia procedure code.
			 Payment for personally performed anesthesia services by an anesthesiologist, or
			 by a CRNA, is 100% of the Total Anesthesia Fee; provided that, if a CRNA is
			 employed by the facility in which the personally performed anesthesia service
			 is provided, governmental units may specify other payment rules for the CRNA's
			 services including, without limitation, specifying that there is no separate
			 payment for the CRNA's services.
(6)
Medical Direction of CRNA
			 Anesthesia Services
. Payment for an anesthesiologist's medical
			 direction of a CRNA, or for the services of a CRNA performed with medical
			 direction of an anesthesiologist for which the governmental unit provides
			 separate payment, may be claimed by appending the appropriate anesthesia
			 modifier to the anesthesia procedure code. If an anesthesiologist provides
			 medical direction of a CRNA, payment for the anesthesiologist's services is 50%
			 of the Total Anesthesia Fee. Payment for the CRNA's services performed with
			 medical direction of an anesthesiologist is 50% of the Total Anesthesia Fee;
			 provided that, if a CRNA is employed by the facility in which the anesthesia
			 service is performed, governmental units may specify other payment rules for
			 the CRNA's services including, without limitation, specifying that there is no
			 separate payment for the CRNA's services.
(7)
Modifiers
. For
			 modifiers and related descriptions applicable to anesthesia services (AA, QK,
			 QY, QX, and QZ),
see
101
			 CMR 316.05(3).