CMS Pub. 100-04, ch. 12, § 140.3.4

Claims for reimbursement for qualified nonphysician anesthetist services should be

completed in accordance with existing billing instructions for anesthesiologists

with the following additions.

• If an employer-physician furnishes concurrent medical direction for a procedure

involving CRNAs and the medical direction service is unassigned, the

physician should bill on an assigned basis on a separate claim for the qualified

nonphysician anesthetist service. If the physician is participating or takes

assignment, both services should be billed on one claim but as separate line

items.

• All claims forms must have the provider billing number of the qualified

nonphysician anesthetist and/or the employer of the qualified nonphysician

anesthetist performing the service in either block 24.H of the Form CMS-1500

and/or block 31 as applicable. Verify that the billing number is valid before

making payment.

Payments should be calculated in accordance with Medicare payment rules in

§140.3. The A/B MAC must institute all necessary payment edits to assure that

duplicate payments are not made to physicians for qualified nonphysician

anesthetist services or to a qualified nonphysician anesthetist directly for bills

submitted on their behalf by qualified billers.

A CRNA is identified on the provider file by specialty code 43. An anesthesiologist’s

assistant is identified on the provider file by specialty code 32.