Anesthesia time is money. Literally.
Anesthesia payment is base units plus time units times a conversion factor, adjusted by medical direction modifiers. Revenue leaks through rounded or recalculated time, wrong AA/QK/QX/QZ pairing, concurrency errors and low out-of-network payments. We audit all four and contest low payments through No Surprises Act IDR.
How anesthesia groups get short-paid.
Time units recalculated
Payers round, cap or recalculate minutes differently from your contract. Small cuts on every case add up fast.
Medical direction modifiers
AA, QK, QX, QY and QZ change payment for the anesthesiologist and CRNA. One wrong pairing halves a line or denies it.
Out-of-network underpayments
Groups at in-network facilities are often paid near the plan's QPA. Under the No Surprises Act, that can be contested through open negotiation and IDR.
The lines that decide your reimbursement.
Anesthesia claims are formula-driven, so small errors in time or modifiers repeat on every case.
Read more
| Code / modifier | What it covers | What goes wrong |
|---|---|---|
| Base units | Fixed value per anesthesia code (ASA crosswalk) | Wrong anesthesia code for the procedure performed |
| Time units | Anesthesia time, typically 15 minutes per unit (Medicare reports actual minutes) | Rounded down, capped or start/stop times unsupported |
| AA | Anesthesia personally performed by the anesthesiologist | Billed while also directing other rooms |
| QK / QX | Medical direction of 2–4 concurrent cases / CRNA service with medical direction | Concurrency count wrong; direction steps not documented |
| QZ | CRNA service without medical direction | Billed where direction was in fact provided |
| P1–P5, qualifying circumstances | Physical status and special circumstances | Missing on claims where contracts pay extra units |
Code descriptions are summarized. Always check the current CPT descriptor, NCCI edits and payer policy.
Strategy backed by experienced specialists.
Strategy & Direct Client Partnership led by Rohit Pandey, backed by a dedicated team of credentialed medical coders (AAPC/AHIMA) and seasoned AR follow-up specialists.
How we work with your team
- We work inside your PM/EHR (eClinicalWorks, NextGen, AdvancedMD and others) under a HIPAA BAA.
- We act as a secondary recovery team on aging AR and complex appeals, alongside your staff.
- Weekly collection reporting to practice leadership.
- 6–7% of net collections; 10% only on No Surprises Act IDR wins.
Anesthesiology billing questions
How are anesthesia claims paid?
Generally as (base units + time units + any modifying units) multiplied by the payer's conversion factor, with medical direction modifiers adjusting the split between anesthesiologist and CRNA. Exact rules depend on the payer and contract.
Can you dispute low out-of-network payments?
Yes. For plans subject to the No Surprises Act, we start open negotiation within the 30-business-day window and file federal IDR if needed, for 10% of what we recover.
Do you handle CRNA billing?
Yes, including medically directed and non-directed CRNA services and the documentation each requires.
10 minutes. One screen. Your numbers.
A short Google Meet with Rohit to look at where your revenue stalls and whether contingency recovery makes sense for your practice. No software change, nothing to pay up front.