Anesthesia Concurrent Cases


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Hi All,

I have a provider that has 3 concurrent cases (1 personally performed, 2 involving residents). Based on CMS' guidelines, each would meet the payment at "Personally Performed Rate", but I'm a little confused because the listed items could be an "Or", and not and/or, which might mean it is medical direction instead of personally performed? Any advice is greatly appreciated.

B. Payment at Personally Performed Rate The A/B MAC must determine the fee schedule payment, recognizing the base unit for the anesthesia code and one time unit per 15 minutes of anesthesia time if:
• The physician personally performed the entire anesthesia service alone;
• The physician is involved with one anesthesia case with a resident, the physician is a teaching physician as defined in §100;
• The physician is involved in the training of physician residents in a single anesthesia case, two concurrent anesthesia cases involving residents or a single anesthesia case involving a resident that is concurrent to another case that meets the requirements for payment at the medically directed rate. The physician meets the teaching physician criteria in §100.1.4;
• The physician is continuously involved in a single case involving a student nurse anesthetist;
• If the physician is involved with a single case with a qualified non-physician anesthetist (a certified registered nurse anesthetist (CRNA) or an anesthesiologist’s assistant)), A/B MACs may pay the physician service and the qualified non-physician anesthetist service in accordance with the requirements for payment at the medically directed rate; Or
• The physician and the CRNA (or anesthesiologist’s assistant) are involved in one anesthesia case and the services of each are found to be medically necessary. Documentation must be submitted by both the CRNA and the physician to support payment of the full fee for each of the two providers. The physician reports the AA modifier and the CRNA reports the QZ modifier.


Sherman, TX
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Please know that an anesthesiologist may not be on a solo case personally performing anesthesia (without a resident/student) and supervise/teach residents concurrently on other cases. Does that help you?