CMS Pub. 100-04, ch. 12, § 140.3

Nonphysician Anesthetists

(Rev. 3883; Issued: 10-13-17; Effective: 01-16-18; Implementation: 01-16-18)

Payment for the services furnished by qualified nonphysician anesthetists are subject

to the usual Part B coinsurance and deductible, and are made only on an assignment

basis. The assignment agreed to by the qualified nonphysician anesthetist is binding

upon any other person or entity presenting a claim or request for payment for the

service. Except for deductible and coinsurance amounts, any person who knowingly

and willfully presents or causes to be presented to a Medicare beneficiary a bill or

request for payment for services of a qualified nonphysician anesthetist for which

payment may be made on an assignment-related basis is subject to civil monetary

penalties.

The fee schedule for anesthesia services furnished by qualified nonphysician

anesthetists is the applicable locality-adjusted anesthesia conversion factor

multiplied by the sum of allowable base and time units, as defined in §50 of this

chapter.

The allowance for an anesthesia service furnished by a qualified nonphysician

anesthetist that meets the requirements for payment at the medically directed rate is

based on a fixed percentage of the allowance recognized for the anesthesia service

personally performed by the physician alone, as specified in §50 of this chapter.

The anesthesia locality-adjusted conversion factor for anesthesia services furnished

by a CRNA that does not meet the requirements for payment at the medically

directed rate may not exceed the allowance for a service personally performed by a

physician, as specified in §50 of this chapter.