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Oral Surgery Anesthesia Code D9243

Effective for services provided on and after February 1, 2017, Horizon Blue Cross Blue Shield of New Jersey will change the way that we calculate the allowance for oral surgery anesthesia procedure code D9243 as noted below.

(2 x Base Value Unit

+

Time Units)

x

Conversion Factor

=

Allowance

Each CPT® code is assigned a base value unit.

 

See below for information on time units.

 

Horizon BCBSNJ’s fixed fee for anesthesia reimbursement

 

Total anesthesia allowance

To help us calculate an accurate allowance, when submitting claims for procedure code D9243, please:

  • Do not submit multiple claim lines of D9243 to indicate multiple units of these services.
  • Provide the total time that anesthesia was provided on the D9243 claim line.

Electronic claim submissions

When submitting anesthesia claims electronically, be sure to include the information noted in the table below.

Loop

Element

Description

2300

NTE02

ADD

2300

NTE03

Anesthesia start to stop time in military time separated by a dash with no spaces (e.g., HH:MM – HH:MM)

2400

SV104

Total number of minutes that anesthesia was provided.

2400

SV103

MJ qualifier

For paper claim submissions

When submitting anesthesia claims on a CMS 1500 form, please include the anesthesia start-to-stop time in military time separated by a dash with no spaces (e.g., HH:MM - HH:MM) in the supplemental information section in Box 24 (shaded upper row).

If you have questions, please contact your Network Specialist.

Failure to follow these claim submission guidelines may result in delays in claim processing and/or inaccurate reimbursement. Horizon BCBSNJ reserves the right to adjust finalized claims that are not processed according to these guidelines.

CPT® is a registered trademark of the American Medical Association.


Time Unit Calculations

Since these anesthesia services are reimbursed based on time units calculated in 15-minute intervals, additional time (less than 15 minutes) will be either rounded up or down by Horizon BCBSNJ upon claim processing.

Additional time greater than eight minutes will be rounded up to the next unit. Additional time less than eight minutes will be rounded down.

For example:

  • 30 minutes of anesthesia is equal to two units (30=15+15)
  • 38 minutes of anesthesia is rounded up to three units (38=15+15+8)
  • 37 minutes of anesthesia is rounded down to two units (37=15+15+7)
Published on: March 23, 2017, 14:46 p.m. ET
Last updated on: March 24, 2017, 05:56 a.m. ET