Outrageous Anesthesia Charges Raise Questions
As healthcare costs continue to climb an upward slope, there is an escalated and ongoing need for closer assessment of healthcare claims to assist in identifying egregious charges, improper medical billing errors and associated improper claim payments.
In this Audit Spotlight, we focus on the varying charges for anesthesia services being reported and billed on the CMS-1500 claim form, or electronic equivalent, and what that means when the calculation of charges is broken down based on a per-minute charge and a per-hour charge basis.
Anesthesia Services and Reimbursement
Anesthesia reimbursement is typically calculated using an anesthesia base unit, plus anesthesia time, multiplied by the applicable locality-adjusted anesthesia conversion factor, based on the date of service. Certain anesthesia modifiers also influence pricing while other anesthesia modifiers are for informational purposes only. The 2026 anesthesia conversion factors have been released by CMS and Medicare anesthesia base units are unchanged for CY 2026.
Each anesthesia CPT procedure code (00100 to 01999) has an assigned anesthesia base unit. Base unit means the value for each anesthesia code that reflects all activities, other than anesthesia time. These activities include usual preoperative and postoperative visits, the administration of fluids and/or blood incident to anesthesia care, and monitoring services.
Anesthesia time as defined by Medicare, means the period during which an anesthesia practitioner is present with the patient. It starts when the anesthesia practitioner begins to prepare the patient for anesthesia services and ends when the anesthesia practitioner is no longer furnishing anesthesia services to the beneficiary, that is, when the beneficiary may be placed safely under postoperative care. Anesthesia time is a continuous period from the start of anesthesia to the end of an anesthesia service. Actual anesthesia time is reported by minutes on the claim.
Anesthesia practitioner, for the purpose of anesthesia time and calculation of anesthesia time units, means a physician who performs the anesthesia service alone, a CRNA who is not medically directed by a physician who performs the anesthesia service alone, or a qualified nonphysician anesthetist who is furnishing services that meet the requirements for payment at the medically directed rate.
Anesthesia Claim Examples
Case One
An Arizona CRNA billed $33,000 for anesthesia services performed during a spinal surgery with CPT code 00670 and modifier QZ. The CRNA billed 128 minutes of anesthesia time.
This equates to charging $257.81 per minute or $15,468.75 per hour for anesthesia care.
Total billed charges for anesthesia claim — $33,000
ClaimDOC pricing — $538.58, based on Medicare rate with markup
Plan savings: $32,461.42
Percentage of savings: 98%
Case Two
A Florida CRNA billed $17,850 for anesthesia service performed during a spinal surgery with CPT code 00670 and modifier QZ. The CRNA billed 110 minutes of anesthesia time.
This equates to charging $162.27 per minute or $9,736.36 per hour for anesthesia care.
Total billed charges for anesthesia claim — $17,850
ClaimDOC pricing — $526.03, based on Medicare rate with markup
Plan savings: $17,323.97
Percentage of savings: 97%
Case Three
A California CRNA billed $2,687.50 for anesthesia service performed during a spinal surgery with CPT code 00670 and modifier QZ. The CRNA billed 127 minutes of anesthesia time.
This equates to charging $21.16 per minute or $1,269.69 per hour for anesthesia care.
Total billed charges for anesthesia claim — $2,687.50
ClaimDOC pricing — $556.59, based on Medicare rate with markup
Plan Savings: $2,130.91
Percentage of Savings: 79%
Case Four
A Colorado CRNA billed $3,450 for anesthesia service performed during a spinal surgery with CPT code 00670 and modifier QZ. The CRNA billed 152 minutes of anesthesia time.
This equates to charging $22.70 per minute or $1,361.84 per hour for anesthesia care.
Total billed charges for anesthesia claim — $3,450
ClaimDOC pricing — $588.76, based on Medicare rate with markup
Plan savings: $2,861.24
Percentage of savings: 83%
The Takeaway
The claim examples above demonstrate a wide range of anesthesia charges reported and billed by anesthesia practitioners for the same code and similar time. When you see a bill that feels outrageous, it probably is. It is essential for patients to understand the total costs of care involved and to discuss with their healthcare providers to ensure they are aware of the potential out-of-pocket expenses and do not face surprise medical bills.
Improper reporting of services, coding and billing errors, and egregious charges can complicate matters for patients to understand complex bills and payments, impact the collection of patient balances, build a reputation of providers charging high fees, create burdens for patients having no insurance, and a host of others.
Given the volume of healthcare claims that are reported and billed each day by providers and suppliers, egregious charges and medical billing errors are alarmingly common and lead to improper payments, potential fraud, abuse and waste.
When an individual receives a healthcare bill that appears questionable or inappropriate, an inquiry to the practitioner or provider and/or health plan should be made to obtain an explanation of the services and corresponding charges.
Our goal at ClaimDOC is to use benchmark charges and costs nationally to negotiate fair and ethical payments. Our high-quality and expert review of claims identifies and prevents improper medical claim payments and maximizes long-term cost savings opportunities. Employers turn to us seeking to establish fair reimbursement rates for their plans, allowing them to save money and provide richer benefits to their employees. A win-win for everyone.
Background
ClaimDOC’s comprehensive line-by-line review of claims uncovers errors that basic claim repricing and auto-adjudication does not catch, leading to greater savings for health plans and its plan members. Our audit team analyzes all types of healthcare claims for a variety of potential concerns including excessive usual and customary charges, duplication of claims, incorrect coding, unbundling of services and many others. Our claims review is not intended to impact care decisions or medical practice.