anesthesia assitants

Can anyone provide me some guidance on billing for Certified Anesthesia Assistants? From what I am reading they can not bill as non medically directed like a CRNA - would like further clarification.



  • In our state of Pennsylvania, we cannot bill for their services. I believe each state may have their own regs regarding AA's and their scope of practice. I doubt if any state would allow then to work without medical direction since their education/training is not near that of a CRNA.

    Gerry Malloy, Partner
    Global Health Management Services, LLC
    Tamaqua, PA 18252

  • edited June 2017
    hi Pam,

    AAs are treated similarly to APRNs - you might want to get this from the "horse's mouth" - check here:

    See specifically slides 6 & 7 that will tell you what's required & how to bill for them.

    Here's another from CMS that might help:

    Also for good measure, I'm including a link to ASA that pretty much says the same thing - but you'll have something to work with that's "in writing", at least & not because someone says so. management/ttppm/anesthesiolgoist assistants and qz july 2013.pdf

    Have a great day!

    Leslie Johnson, CPC

    Know what you know & Know Why you Know It!

  • I do billing for CRNA's,,,sometimes I will have 2 or more procedures done in one visit is there another modifier I can use for them? And also what if they have one procedure then are brought back to the operating room for another proc, can I also use a different modifier for this as well?
    I have called inquiring about this but the representatives wont advise me on what to do.....
    Any help would be greatly appreciated!

  • edited June 2017
    Hi Sherry,

    This is going to be payer-specific.

    Most have wanted modifier 59 in the past, for separate/different session or encounter.

    Now some are wanting modifier 76 for repeat procedure - as in repeat anesthesia services. I don't especially agree with this one, but if you're going to play the game with a payer, you have to play by their rules.

    I wouldn't recommend modifier 78 - but then again, as I understand it, an unplanned return to OR for a complication is still a return to OR.

    I know, I know - clear as mud, yeah? At least you have these 3 options you can go with.

    Do yourself a favor & keep track of what these payers are wanting so you can refer to your own list later. Good luck!

    Leslie Johnson, CPC

    Know what you know & Know Why you Know It!

  • edited June 2017
    Do you mean two or more procedures done during the same operative session? If so, you can only bill one anesthesia code, per operative session.

  • edited June 2017
    I agree with you Lisa; for more than a single procedure done at the same encounter/session, the rules state that we are to report the procedure that has the highest base value.
    I've actually seen some payers wanting us to report all those procedures and they say that *they* will select the higher based valued procedure - but honestly, I don't know too many people who actually do that.
    Every rule has its exceptions - Labor to C/S is one of them.  The rules also don't include post-op pain procedures or some other procedures, such as A-lines, CVP & a few others that could be done at the same encounter.  When you don't know, best to look it up in the Relative Value Guide book (MUST HAVE) or check out ASA Standards here:
    In my initial response, I addressed the 2nd encounter on the same day but at a different session but failed to address the 2 procedures done at the same time.
     Leslie Johnson, CPC

    Know what you know & Know Why you Know It!
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