By Pam Linton, Manager, Corporate Coding | February 19, 2021
Effective May 1,2021, CIGNA will change the way it calculates your anesthesia time units. Currently, reimbursement for anesthesia time units is calculated so that every 15-minute increment (or part thereof) equals 1 time unit. Beginning May 1, 2021 however, reimbursement will be based on actual time billed rounded to nearest 10th of a unit, which is currently how CMS processes anesthesia time. This will result in a slightly lower reimbursement for most anesthesia claims.
Example: A Laparoscopic Cholecystectomy (7 base units) with 66 minutes of anesthesia time with a contracted rate of $75 per unit
Current payment methodology
7 base units + 5 time units = 12 total units. 12 x $75 = $900 (allowed amount)
New payment methodology
7 base units = 4.4 time units = 11.4 total units. 11.4 x $75 = $855 (allowed amount)
Cigna will update their administrative guidelines in the CIGNA Reference Guide with this information by March 1, 2021. As an RCM industry partner, we will continue to monitor payer guidelines to see if other national payers follow CIGNA on this issue. Stay tuned for these issues and more on the resources section of the Zotec website.