Specialty billing · Anesthesia

Anesthesia Billing Services

Every base unit, time unit, and care-team modifier — captured.

247 Medical Billing Services delivers anesthesia billing services that capture every base unit, time unit, and care-team modifier across anesthesiology groups, CRNA practices, and pain physicians. Since 2005, we've run the full revenue cycle for Medicare, commercial, and out-of-network payers — with a dedicated account manager, a free 360° reporting dashboard, and HIPAA-compliant, SOC 2 Type II security behind every claim.

Request a Revenue Review Call +1 888-502-0537
HIPAACompliant SOC 2Type II Serving Since2005 Specialty-FocusedRCM
Case payment assembly ASA 00790 · Live
Procedure Laparoscopic cholecystectomy · ASA Crosswalk
Base unitsfrom the crosswalk7.00
Time units92 min ÷ 156.13
Modifying unitsphysical status P31.00
Total units 0.13units

× conversion factor$20.4976 · CY2026 national

Care-team modifier sets the percentageQK · 50%

Concurrency · 1:4 cap 5th room = supervision (AD)
TEFRA conditions

7 / 7documented

split holds at 50/50
Time reconciled to AIMSDays in A/R < 25
We work with Anesthesia groups across the U.S. General Anesthesia Regional Anesthesia MAC CRNA Services Pain Procedures
01Not RVUs — a formula

The formula that sets every anesthesia payment

Anesthesia is the only specialty Medicare doesn't pay on RVUs. Payment is assembled from a formula — (base units + time units + modifying units) × the anesthesia conversion factor — and each input is a place to win or lose money.

Miss a base unit on the ASA Crosswalk, round the minutes, drop a payable physical-status unit, or leave a medical-direction attestation incomplete, and the money either shrinks quietly or comes back as a takeback. We manage every variable in the formula so each case is paid to its true value — nothing rounded away, nothing left uncaptured.

Base unitsA fixed value per anesthesia CPT (00100–01999), assigned through the ASA Crosswalk. 00100–01999crosswalk
Time unitsThe 15-minute convention, measured under the continuous-presence start/stop rule. ÷ 15 mincontinuous presence
Modifying unitsPhysical status (P3 +1, P4 +2, P5 +3) and qualifying circumstances (99100, 99116, 99135, 99140). P3 +1 · P4 +2 · P5 +3payer-dependent
Conversion factorA separate national anesthesia CF ($20.4976 for CY2026), locality-adjusted; commercial CFs differ by contract. $20.4976CY2026 national
Care-team modifierAA / QK+QX / QY / QZ / AD — the modifier that sets the payment percentage. AA · QK · QY · QZ · ADsets the split
What we manage every input, every case
02Coded to the room, never to a default

Every anesthesia case, coded to its own rulebook

Three truths make this specialty its own discipline, and each is where a generalist quietly bleeds your revenue.

TRUTH 01The care-team modifier is worth half the case.A single wrong character swings a claim from full payment to a 50% split.
TRUTH 02Medical direction is the most-audited service in anesthesia.The seven TEFRA conditions and the 1:4 concurrency cap are conditions of payment, not clerical notes.
TRUTH 03Out-of-network is routine, not the exception.The No Surprises Act reshaped anesthesia more than almost any other specialty, so qualifying-payment-amount reviews and IDR deadlines are part of everyday collections.

AA100%

Personally performed

The physician who does the case collects 100% of base plus time. We confirm the documentation supports personal performance rather than a supervised model.

QK / QY50 / 50

Medical direction

QK or QY on the physician claim, QX on the anesthetist claim. We bill this split only when all seven TEFRA conditions are met and documented and the physician stayed within the four-room cap.

QZ100%

Independent CRNA

Where state scope of practice and Medicare opt-out status allow, a non-medically-directed CRNA is paid at 100%. We code QZ to real, documentable staffing rather than as a default.

ADflat

Medical supervision

When a physician oversees more than four concurrent rooms, payment drops to a flat unit basis. We flag supervision before it happens so you can staff around it instead of discovering it on the remittance.

Seven TEFRA conditions documentedIncluding presence at induction and emergence, on every QK/QY case.Owned by 247MBS
Evidence required
Attestation on the anesthesia record for each directed case.
If it fails
Downgrade to medical supervision (AD), or false-claims exposure.
1:4 concurrency cap heldThe directing physician stays within four concurrent rooms.Flagged before the case
Evidence required
Room-by-room concurrency across the day's board.
If it fails
The split collapses to supervision on a flat unit basis.
Billed time matches the recordMinutes reconciled to the anesthesia record and AIMS timestamps.Reconciled pre-submission
Evidence required
Continuous-presence start and stop times.
If it fails
Time-unit denial and a time-integrity audit.
03Staffing model decides the modifier

Who we serve

The rules shift with the setting, and we bill each one to the detail it demands:

Care-team groups

Anesthesiology groups & care-team models

Multi-facility staffing where concurrency, modifiers, and directing-physician documentation have to line up across every room, every day.

What decides the moneyConcurrency held inside 1:4, with TEFRA documented per directed case

CRNA & AA

CRNA & AA practices

Independent QZ billing where scope and opt-out status allow, and QX billing under medical direction where they don't.

What decides the moneyQZ vs QX coded to real staffing, not a default

ASC & office-based

Ambulatory surgery centers & office-based anesthesia

High-volume, fast-turnaround case flow that lives or dies on clean first-pass submission.

What decides the moneyFirst-pass clean-claim rate at volume

Obstetric & hospital

Obstetric & hospital-based anesthesia

Labor epidurals, where "anesthesia time" rarely maps cleanly to the clock and each payer defines its own time method; we bill to the contract instead of guessing.

What decides the moneyThe payer's own definition of anesthesia time

Pain physicians

Pain management physicians

Interventional and chronic-pain work that overlaps anesthesia coding; see our dedicated pain management billing services for that side of the practice.

What decides the moneyInterventional coding kept distinct from anesthesia time

04Erosion, not obvious denials

Outsource anesthesia billing services

The problem

Anesthesia is unforgiving in a way most specialties aren't: the revenue doesn't disappear in obvious denials, it erodes case by case.

How it erodes

Through downgraded medical direction, minutes rounded the wrong way, and out-of-network balances written off because nobody chased the qualifying payment amount.

The fragility

An in-house biller — however good — has to master the ASA Crosswalk, six care-team modifiers, TEFRA, and No Surprises Act workflows alone, and one vacancy can stall your entire cash flow. When you outsource anesthesia billing services to a team that already lives inside those rules, that fragility goes away.

The trade

Outsourcing here isn't about cutting a line item; it's about converting a fixed salaried cost into a transaction-based fee that only grows when your collections do — and about putting certified anesthesia coders, denial specialists, and enrollment staff on your account instead of a single generalist.

The payback

For groups that feel every 50% downgrade and every out-of-network write-off, that is usually where the leaked revenue comes back.

What outsourcing looks like with us

Outsource Anesthesia Billing — What Outsourcing Looks Like With Us

Outsource anesthesia billing to us and the revenue that erodes case by case — downgraded medical direction, minutes rounded the wrong way, out-of-network balances nobody chased — stops depending on one in-house biller who has to master the crosswalk, six modifiers, TEFRA, and No Surprises Act workflows alone.

The math is why groups make the move: a transaction-based fee that grows only when your collections do replaces a fixed salary and its single point of failure. For a group that feels every 50% downgrade, anesthesia billing services outsourcing pays for itself fast.

Start with a revenue review or call +1 888-502-0537.

Outsourcing anesthesia billing services means a certified team owns
  • Coding
  • Care-team modifiers
  • Minute-accurate time
  • 24-hour submission
  • QPA disputes & IDR
  • A/R follow-up
across Medicare, commercial and out-of-network payers
  • DATAEvery claim visible on one live dashboard
  • DENIALSUp to 90% of worked denials overturned
  • TERMSNo long-term lock-in

Revenue review

Put a dollar figure on the units your cases are losing.

A certified anesthesia specialist reviews your medical-direction downgrades, lost time units, and aged A/R — and puts a number on what they are quietly draining from collections.

  • Care-team modifiers checked against your real staffing
  • Billed minutes reconciled to the anesthesia record
  • Out-of-network qualifying payment amounts reviewed
HIPAA & SOC 2 Type II Back within one business day No long-term lock-in
Request a Revenue Review

Tell us about your group.

An anesthesia billing specialist will reach out within one business day.

HIPAA-secure · No obligation · We never share your data

Thanks — we've got it.

An anesthesia billing specialist will reach out within one business day.

05Record to paid, one team

What our anesthesia billing covers

Everything it takes to move an anesthesia claim from the record to paid, run by one certified team rather than split across vendors:

  1. 01Code

    Anesthesia coding & the ASA Crosswalk

    Surgical procedures translated to the correct 00100–01999 code, one code (highest base) per session, with physical-status and qualifying-circumstance units captured wherever the payer reimburses them.

  2. 02Attest

    Care-team modifier & TEFRA compliance

    AA, QK, QY, QX, QZ, and AD matched to your staffing, with the seven medical-direction conditions and the concurrency cap documented on every directed case.

  3. 03Submit

    Charge capture & clean-claim submission

    Time reconciled to the anesthesia record and AIMS to the minute, scrubbed, and filed within 24 hours.

  4. 04Appeal

    Denial management and appeals

    Every denial worked to root cause, including qualifying-payment-amount disputes and No Surprises Act IDR filed inside the deadline.

  5. 05Recover

    Accounts-receivable recovery

    Aged claims pursued relentlessly across Medicare, commercial, and out-of-network payers.

  6. 06Enroll

    Provider credentialing and payer enrollment

    Physicians, CRNAs, and AAs enrolled and re-credentialed so nothing rejects on provider eligibility.

If you'd rather keep anesthesia billing and coding services under one roof, that's exactly the model — certified coders and billers on the same team, sharing the same record, instead of handing your claims between companies.

06Where anesthesia revenue leaks

Why anesthesia groups choose 247MBS

Bringing us on isn't hiring a general biller who happens to accept anesthesia claims. It's hiring an anesthesia billing services company that already knows where anesthesia revenue leaks and how to stop it.

We protect medical-direction revenue.7 TEFRA · 1:4 cap

All seven TEFRA conditions and the concurrency cap are documented on every QK/QY case, so directed claims hold at the 50/50 split instead of quietly downgrading to supervision.

We defend your time units.record + AIMS

Billed time is reconciled to the anesthesia record and AIMS timestamps, never rounded or padded — which removes both the underbilling and the time-integrity audit risk.

We win the MAC medical-necessity fight.QS · G8 · G9

MAC for GI endoscopy is documented to each payer's local coverage determination, with QS and G8/G9 applied correctly, so those high-volume cases stop bouncing.

We actually collect out-of-network.QPA · IDR deadline

The qualifying payment amount is reviewed on every out-of-network claim, and IDR is opened inside the deadline rather than written off as a loss.

You always see the work.named manager · live dashboard

A named account manager owns your account and a free 360° dashboard shows every claim, denial, and dollar — with no long-term lock-in holding you there.

What the numbers hold, month after month

Groups that move to us typically see:

0%
First-pass clean-claim rate
0%
Net collections
up to 0%
Fewer denials
<0
Days in A/R
~0 of 10
Worked denials overturned on appeal
0%
Client-retention rate

We hold a 98% client-retention rate because those numbers hold month after month, and every claim is scrubbed and filed within 24 hours instead of aging in a work queue.

07The difference on the remittance

247MBS vs. a general biller

A generalist learns anesthesia on your claims. Our professional anesthesia billing services show up already fluent in it — and the difference lands on the remittance:

Capability
General billing company
247MBS
ASA Crosswalk & base-unit codingOne code, highest base, per session.
No
Yes
Care-team modifiers (AA/QK/QY/QX/QZ/AD)One wrong character is half the case.
Limited
Full
Seven TEFRA conditions & 1:4 concurrencyConditions of payment, not clerical notes.
No
Yes
Time reconciled to the anesthesia record/AIMSRemoves underbilling and audit risk together.
No
Yes
MAC medical necessity (GI endoscopy LCDs)High-volume cases that otherwise bounce.
No
Yes
No Surprises Act QPA disputes & IDROut-of-network is routine in anesthesia.
No
Yes
Dedicated account manager & live dashboardEvery claim, denial and dollar, no lock-in.
Sometimes
Always
08Risk → exposure → prevention

The anesthesia denials we prevent

Most anesthesia losses trace back to the same handful of failure points. We close each one at the front end, before it becomes a denial or a recoupment:

Billing mistake
Most audited

Medical direction (QK/QY) without all seven TEFRA conditions documented

What it can trigger

Downgrade to medical supervision (AD) or false-claims exposure

How 247MBS prevents it

We attest and document all seven conditions and hold the 1:4 cap

Billing mistake

Billed time vs. anesthesia record mismatch

What it can trigger

Time-unit denial and time-integrity audit

How 247MBS prevents it

We reconcile every minute to the record/AIMS; continuous presence only

Billing mistake

MAC for GI endoscopy without documented necessity

What it can trigger

Medical-necessity denial against the payer LCD

How 247MBS prevents it

We document MAC necessity to the LCD and apply QS/G8/G9 correctly

Billing mistake

Wrong ASA Crosswalk or base-unit upcoding

What it can trigger

Downcode, recoupment, or unbundling denial

How 247MBS prevents it

We apply the Crosswalk and report one code (highest base) per session

Billing mistake

Out-of-network underpayment (No Surprises Act)

What it can trigger

Payment below the fair rate, then written off

How 247MBS prevents it

We review the QPA and open IDR inside the deadline

Billing mistake

Post-op block unbundled without the surgeon's request

What it can trigger

59/XU unbundling denial

How 247MBS prevents it

We bill blocks only with a documented request and the correct modifier

Every one of these is preventable before submission rather than argued after the fact. Request a revenue review and we'll show you which of them is hitting your remits right now.

09No gap in cash flow

Onboarding without a cash-flow gap

Changing billers shouldn't mean a gap in cash flow, and with us it doesn't.

No new platform

We work inside your existing practice-management and anesthesia information-management systems, so nobody relearns a platform.

Claims keep going out

Credentialing and payer-enrollment review run in parallel while your claims keep going out the door, and a named account manager leads the transition from day one.

Live in weeks

Most anesthesia groups are fully live within a few weeks.

The denial drop and the faster A/R show up in the first cycles, not a quarter later.

10Every unit the formula earns

Medical Billing for Anesthesia

Hand us your medical billing for anesthesia and you collect every unit the formula earns — base, time, and modifying units at the payer-correct conversion factor.

Because so much anesthesia revenue now rides on medical-direction attestations and out-of-network qualifying payment amounts, we work compliance and appeals as daily workflow, not an afterthought. Groups that move their medical billing to us typically see denials fall by up to 40%, clean claims near 99%, net collections near 99%, and days in A/R under 25 — directed cases whole, time defensible, out-of-network balances collected instead of written off. Request a revenue review and we'll price the units you're losing today.

  • BASEThe right crosswalk baseOne code, highest base, per session.
  • TIMEMinute-accurate timeReconciled to the anesthesia record and AIMS.
  • UNITSPhysical status and qualifying circumstancesCaptured on the payers that reward them.
  • MODIFIERA care-team modifier that mirrors the roomNever a default.
11A decision framework

Choosing an Anesthesia Billing Services provider

Choose the provider that already lives inside the formula — the one that can explain a medical-direction downgrade, reconcile billed minutes to the anesthesia record, and open an IDR inside the deadline without reaching for a playbook.

  • TEFRA on every directed caseAll seven conditions documented, not sampled.
  • Modifiers coded to true staffingAA, QK, QY, QX, QZ and AD, never a default.
  • QPA reviewed on every OON claimWith IDR opened inside the deadline.
  • Certified anesthesia codersAAPC/AHIMA coders on the same team as the billers.
  • A free live dashboardEvery claim reported as it moves.
  • Fees priced against real collectionsWith no long-term lock-in.
We document all seven TEFRA conditions — including presence at induction and emergence — on every QK/QY case and enforce the four-room concurrency cap, so the 50/50 split holds and there's no supervision downgrade or audit exposure.
Yes. We code independent CRNA work as QZ (100%) where state scope and Medicare opt-out status allow, and medically directed CRNA or AA work as QX under the physician's QK/QY — always matched to your actual staffing model rather than a default.
Yes. We review the qualifying payment amount on every out-of-network claim, dispute underpayments, and file the federal IDR inside the deadline instead of writing off the balance — a core part of anesthesia collections today.
We do. Certified anesthesia coders and billers work as one team, so the ASA Crosswalk, the care-team modifiers, and claim submission all stay aligned instead of being split across two vendors.
Usually more so, not less. Smaller groups feel every downgraded case and every written-off out-of-network claim, and a transaction-based fee replaces the cost of an in-house biller who has to master anesthesia's rules alone.
Most groups are live within a few weeks. We bill from your existing practice-management and AIMS setup, run credentialing and enrollment review in parallel, and assign a dedicated account manager on day one.

Where we bill

Anesthesia billing, state by state

Every state pays this specialty differently, and that difference lands on the lines that decide the month. Each state page carries its own programs, authorities and rules — and links on to the 291 city pages beneath it.

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Local pages

291 city pages sit beneath these states, each covering that market's payer mix, the operators we bill for there, and the denials we prevent.

ASA Crosswalk·care-team modifiers·TEFRA·No Surprises Act

Ready to get more of your anesthesia claims paid the first time?

Whether you're an independent anesthesiologist, a large care-team group, a CRNA practice, or an ASC, our anesthesia billing services protect every unit of every case. Put the formula, the care-team modifiers, and the No Surprises Act in the hands of a team that treats them as routine — and pull the revenue you're leaving on the table back where it belongs.

Request a Revenue Review Call +1 888-502-0537

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