Anesthesia Billing & Time Units Calculator

Locality rates: CMS 2026 anesthesia conversion factors (ANES2026, RVU26D October release). Medicare Part B only — commercial payers set their own by contract.

2026 Medicare Anesthesia Conversion Factors by Locality

CMS publishes a separate anesthesia conversion factor for every Medicare payment locality. For 2026 the national figure is $20.4975 per unit for clinicians who are not Qualifying APM Participants, and $20.5998 for those who are, both including the 2.5% statutory increase built into the 2026 rates. Across the 109 localities the standard rate runs from $19.42 in Arkansas to $23.26 in New York (NYC Suburbs/Long Island), with Alaska higher still at $28.15. Choose your locality in the calculator above to use the exact figure, or find it in the table below.

The two columns exist because the 2026 Medicare Physician Fee Schedule has two conversion factors: a higher one for Qualifying APM Participants (QPs) and a standard one for everyone else. If you are not certain your group holds QP status for 2026, use the standard figure. Commercial and Medicaid plans set their own anesthesia conversion factors by contract, so these figures apply to Medicare Part B claims only.

How Anesthesia Payment Actually Works

Unlike every other specialty, anesthesia is not paid per procedure — it is paid by formula: (Base Units + Time Units + Modifying Units) × Conversion Factor. The base units come from the anesthesia CPT code (00100-01999) and reflect the complexity of the case — a cataract runs low single digits, an open heart case runs high teens. Time units are the continuous anesthesia time divided by 15 minutes — Medicare uses the exact decimal (63 minutes = 4.2 units), while some commercial contracts round by their own rules. The conversion factor is dollars per unit: Medicare publishes locality-specific anesthesia CFs each year (nationally in the low $20s), and commercial contracts set their own, often substantially higher.

Time: Where Anesthesia Money Is Won and Lost

Anesthesia time starts when the anesthesia provider begins continuous preparation of the patient in the operating area and ends at safe transfer of the patient to post-anesthesia care — a definition measured in provider attention, not skin incision to surgical closure. Documented start and stop times, to the minute, are the whole ballgame: five undocumented minutes per case, across two thousand cases a year, is a five-figure donation to payers. Discontinuous time (an interrupted start) has payer-specific handling, and time records that always end in :00 or :15 are the pattern auditors sort for first.

Modifying Units and Required Modifiers

• ✔ Physical status modifiers (P1-P6): many commercial payers add units for sicker patients - commonly P3 +1, P4 +2, P5 +3. Medicare pays none of them - which is why the calculator separates modifying units
• ✔ Qualifying circumstances (99100-99140): extreme age, hypothermia, hypotension, emergency - add-on codes worth units under many commercial contracts, not Medicare
• ✔ Provider modifiers are mandatory: AA (personally performed), QY (medical direction of one CRNA), QK (medical direction of 2-4 concurrent cases), AD (supervision of more than 4), QX (CRNA with medical direction), QZ (CRNA without medical direction). They split payment - medical direction divides the allowable between physician and CRNA claims - and a missing or contradictory pair denies both claims. See the full anesthesia modifier guide
• ✔ Medical direction has documentation duties: the seven required physician activities (pre-anesthetic exam, prescribing the plan, personally participating in critical portions, and so on) must be in the record for QK claims to survive audits

Worked Example

Laparoscopic procedure, base 7 units. Anesthesia time 08:02 to 09:05 = 63 minutes = 4.2 time units. Commercial patient, P3 status on a contract paying +1 unit, CF $52 (typical commercial CFs run far above Medicare): (7 + 4.2 + 1) × $52 = $634.40. Same case for Medicare at a $21 CF with no status units: (7 + 4.2) × $21 = $235.20. Two lessons in one example: commercial anesthesia contracts are where the revenue is, and the modifying-unit rules differ payer by payer — exactly what the calculator's fields let you model.

The Denials That Haunt Anesthesia Claims

Anesthesia AR problems cluster in predictable places, and most trace back to the formula's inputs. Missing or contradictory provider modifiers lead the list — a QK physician claim without the matching QX CRNA claim (or vice versa) stalls both, because the payer cannot split a payment it can only see half of. Time discrepancies come second: the anesthesia record says 96 minutes, the claim says 105, and the difference triggers a records request that delays the whole case. Base-unit mismatches follow surgery-code changes — when the surgeon's final coded procedure differs from the scheduled one, the anesthesia crosswalk must be re-run, not assumed. And medical-direction ratio problems (a physician directing more concurrent cases than the modifier allows) convert whole days of claims into audit findings. The calculator's job in all of this is expectation-setting: when you know a case should allow $634.40 and the remit shows $412, you catch the underpayment at posting instead of never. Run every significant case's expected allowable, post payments against it, and anesthesia underpayments stop hiding in plain sight — the same expected-versus-actual discipline that catches multiple-procedure mis-rankings works even better here, because the formula leaves payers nowhere to hide.

Why Anesthesia Units Are Rounded Differently to Everything Else

Anesthesia is the one place in billing where partial units are normal. Most timed services round to whole units; anesthesia time is converted at a fixed number of minutes per unit — commonly 15, though some payers use 10 — and many payers accept fractional time units rather than forcing a round number. A 47 minute case at 15 minutes per unit is 3.13 time units, not 3.

That single difference is worth checking in your contract before anything else, because rounding down to 3 on every case is a quiet, permanent revenue loss that never appears as a denial. The claim pays. It just pays less than it should have, on every case, forever.

The second contract variable is the conversion factor. Anesthesia uses its own conversion factor, entirely separate from the Medicare Physician Fee Schedule figure used for other services, and it is locality-adjusted. Using the general conversion factor here produces a number that looks plausible and is wrong — which is more dangerous than a number that is obviously wrong.

Finally, remember what the formula does not include. Qualifying circumstances, physical status modifiers and medical direction ratios all change the final payment, and medical direction in particular splits the payment between the anaesthesiologist and the CRNA rather than paying it twice.

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