Anesthesia billing services for CRNA and MD groups, designed to reduce denials, speed cash flow, and keep compliance airtight.
Anesthesia billing is unlike any other specialty. Every claim is calculated using base units, time units, modifiers, and payer-specific rounding rules. A missed timestamp, an unsupported direction log, or a misplaced modifier can shrink your reimbursement, or worse, trigger an audit.
At Scionis RCM, we align directly with how anesthesia is practiced in the OR. Our team specializes in billing for both CRNA and MD models, using real-time reconciliation, strict compliance with ASA guidelines, and payer-specific edits. The result: cleaner claims, faster reimbursements, and full audit readiness.
Common Anesthesia Billing Mistakes That Drain Revenue
Even experienced groups lose money to preventable mistakes:
- Inaccurate start/stop times or missed discontinuous time
- Wrong direction vs. supervision billing (AA, QK, QY, QX, QZ, AD)
- Payers rejecting claims for missing or wrong physical status modifiers (P3–P5)
- Time-unit rounding applied inconsistently across payers
- Late submissions outside timely filing limits
- Missing documentation to back CRNA/MD medical direction
That’s why many practices outsource their anesthesia billing services to partners who understand time, units, and modifier compliance..
Our Anesthesia Billing Solution
Time and Unit Accuracy
- Reconcile minutes with anesthesia records, EMR, and surgical logs
- Apply payer-specific rounding (10 vs. 15 minutes) correctly
- Exclude discontinuous time with full documentation
Care-Team and Modifier Compliance
- Confirm TEFRA’s 7 steps before billing medical direction
- Apply AA, QK, QY, QX, QZ, AD accurately to reflect supervision levels
- Capture physical status modifiers (P1–P6) and qualifying circumstances
Clean Claim Submission
- Map surgical CPTs to correct anesthesia codes (00100–01999) with ASA CROSSWALK®
- Pre-claim checks for missing data, modifier conflicts, and payer edits
- Most anesthesia claims submitted within 48 hours
Denial Management and A/R
- Denials tracked by root cause (time, modifier, documentation, eligibility)
- Aggressive, targeted appeals with audit-ready support
- Daily A/R worklists until every claim is closed
Transparent Reporting
- Weekly dashboards on claim lag, denial trends, and payer performance
- Audit-ready case-level reporting available anytime
Sub-Specialty Anesthesia Billing Expertise
- Pain Management Billing
Nerve blocks, epidurals, spinal cord stimulators, coded and billed correctly, with clear linkage and modifiers. - Obstetric Anesthesia Billing
Labor epidurals and C-section cases (01961, 01967) documented with strict adherence to OB-specific rules. - Cardiac Anesthesia Billing
CABG, valve procedures, TEE anesthesia, handled with base unit adjustments and compliance checks. - Pediatric Anesthesia Billing
Capturing qualifying circumstances (e.g., CPT 99100 for extreme age) and audit-proof records. - ASC and Hospital Settings
Tailored workflows for high-volume ASCs and complex hospital anesthesia departments.
Where Groups Lose Money (and How We Fix It)
- Time Capture: Missed or over-reported minutes → Full reconciliation with EMR and logs
- Direction Logs: Down-coded to supervision → TEFRA-confirmed direction steps before billing
- Modifier Use: Wrong or missing → Modifier logic built into edits and double-checked by coders
- Missed Services: Nerve blocks, invasive lines not billed → Charge capture checklists and coder prompts
- Late Claims: Filed after deadlines → 48-hour claim turnaround and TFL alerts
Case Study: CRNA/MD Group, Midwest ASC
Problem
High volume of modifier-related denials, frequent down-codes from direction to supervision, slow reimbursements due to late claims.
Our Fix
- Introduced standardized anesthesia time capture workflow
- TEFRA-compliant medical direction documentation
- Modifier logic aligned to payer rules, with pre-claim scrubbing
Results (90 days)
- 41% drop in modifier-related denials
- Claim lag cut from 5.9 to 2.4 days
- Collections up 8% with fewer down-codes
What You Can Expect With Scionis RCM
- 2% average increase in time-unit revenue where under-reporting existed
- 41% reduction in modifier-related denials
- 100% compliance on Medicare direction audits
Claim lag cut by half with 48-hour turnaround
Anesthesia Billing FAQs
1. Can an anesthesiologist and CRNAs bill above 100% in a care team model?
No. Most payers, including Medicare and commercial insurers, cap reimbursement at 100% of the allowed fee per case, even when an anesthesiologist supervises multiple CRNAs. Payments are typically split (e.g., 50/50), and exceeding this amount is rare unless specified in a private payer agreement. A solid RCM partner ensures modifiers like QK and QX are applied correctly to capture the full allowed amount without risking compliance.
2. Are anesthesia services for MRIs or PET scans billed separately?
Yes. When a dedicated anesthesia provider delivers sedation for imaging (like MRI or PET), it’s billed under specific anesthesia CPT codes and reimbursed independently from the imaging fee. These services are not bundled, provided medical necessity is documented. We handle these cases precisely with the right CPT codes and units to maximize payment.
3. When is Monitored Anesthesia Care (MAC) or conscious sedation billable?
MAC is separately billable when performed by an anesthesia professional. Moderate (conscious) sedation is only billable if provided by the same physician doing the procedure, using different CPT codes (99151–99157), and only when not bundled into the primary procedure. We ensure the correct coding path is used based on the provider and sedation level.
4. What documentation is required for CRNA medical direction compliance?
To bill at the full medical direction rate, anesthesiologists must follow the 7-step TEFRA rule: pre-op eval, plan development, key procedure involvement, continuous presence, and post-op care, among others. Missing even one step requires downgrading to medical supervision, which drastically reduces payment. We flag and prevent this through compliance checks.
5. Can post-op pain blocks or epidurals be billed in addition to surgical anesthesia?
Yes, if placed solely for post-op pain and properly timed/documented. The block must be separate from the surgical anesthetic and requested by the surgeon. Using correct CPT codes (e.g., 644xx or 62320–62327) with appropriate modifiers (like -59), our billing team ensures these high-value services are recognized and reimbursed appropriately.
Get Started with Scionis RCM
Anesthesia billing requires precision, expertise, and a strategic approach to ensure that every service is accurately documented, coded, and reimbursed. Scionis RCMs provides a complete billing solution that helps anesthesia practices maximize revenue, reduce denials, and streamline operations. With our advanced systems, expert team, and commitment to excellence, we make anesthesia billing seamless and efficient.
Contact Scionis RCMs today to learn more about how our comprehensive anesthesia billing services can enhance your practice’s revenue cycle.
Want to work with us?
Partner with Us to Drive Excellence
Unlock your healthcare organization’s true financial potential with Scionis RCMs. We specialize in streamlining complex revenue processes, recovering lost revenue, and optimizing cash flow. With our expertise, you can focus on delivering exceptional patient care while we enhance your financial efficiency and growth.
Want to work with us?
Partner with Us to Drive Excellence
Unlock your healthcare organization’s true financial potential with Scionis RCMs. We specialize in streamlining complex revenue processes, recovering lost revenue, and optimizing cash flow. With our expertise, you can focus on delivering exceptional patient care while we enhance your financial efficiency and growth.
Our Expertise
