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Provider Handbook
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Calculating Anesthesia Reimbursement
Anesthesia Procedure Pricing Calculator |
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Calculating Anesthesia Reimbursement |
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The following formula is used to calculate the TRICARE anesthesia reimbursement:
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(Time Units + Relative Value Units)
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Conversion Factor
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Base Unit—TRICARE anesthesia reimbursement is determined by calculating a base unit, derived from the Medicare Anesthesia Relative Value Guide, plus an amount for each unit of time the anesthesiologist is in attendance (in the presence of the beneficiary). A base unit includes reimbursement for:
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- Preoperative examination of the beneficiary
- Administration of fluids and/or blood products incident to the anesthesia care
- Interpretation of non-invasive monitoring (e.g., electrocardiogram, temperature, blood pressure, oximetry, capnography, and mass spectrometry)
- Determining the required dosage/method of anesthesia
- Induction of anesthesia
- Follow-up care for possible postoperative effects of anesthesia on the beneficiary
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Placement of arterial, central venous, and pulmonary artery catheters and use of transesophageal echocardiography are not included in the base unit value. When multiple surgeries are performed, only the relative value units (RVUs) for the primary surgical procedure are considered, while the time units should include the entire surgical session. Note: This does not apply to continuous epidural analgesia.
Time Unit—Time units are determined in increments of 15 minutes. Any fraction of a unit is considered a whole unit. Anesthesia time starts when the anesthesiologist begins to prepare the beneficiary for anesthesia care in the operating room or in an equivalent area. It ends when the anesthesiologist is no longer in personal attendance and the beneficiary may be safely placed under post-anesthesia supervision. Providers must indicate the number of time units in the Days, Units, or Time box of the CMS-1500.
Conversion Factor—The sum of the time units and RVUs is multiplied by a conversion factor. Conversion factors differ between physician and non-physician providers and vary by state, based on local wage indexes.
For more specific information on anesthesia reimbursement calculation and methodologies, see the TRICARE Reimbursement Manual.
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Anesthesia Procedure Pricing Calculator |
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Go to TRICARE's anesthesia section for an anesthesia rate calculator. You’ll see a Web-form on the screen. Just fill in the blanks and click “Search.” The procedure pricing is based on the locality code. You can select a locality code for the geographic region you are querying, or you may look up locality codes by selecting a state, entering a catchment area code, or entering a ZIP code. |
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