Anesthesia Conversion

Different payers report anesthesia rates in different units. The pipeline applies payer-specific formulas to convert to dollars per case.

The Problem

Anesthesia services are priced using "base units" — a code-specific CMS weight that reflects complexity. Different payers report:

• Rate per base unit (multiply by base units to get total)
• Rate per total units (base units + time units already bundled)
• Flat case rate (no conversion needed)

Without knowing the convention for each payer, the raw rate is uninterpretable. Clear Rates applies payer-specific formulas derived from payer documentation and empirical validation.

Payer-Specific Formulas

Payer IDs	Formula	Convention
47, 391, 643, 567	rate (as-is)	Flat case rate or per-time-unit
76 (code 99100 only)	rate (as-is)	Special case
44	rate × 15	Per minute; 1 base unit = 15 minutes
7, 42, 160, 389, 392, 229, 53, 54, 403, 388, 461, 111, 61, 56, 51, 390	rate / (base_units + 1)	Per total units
299	rate / (base_units + 15)	Bundles 15 extra time units
43, 101, 168, 169, 628, 638, 49, 76	rate / base_units	Per base unit

Output Columns

For each payer negotiated type, the transformation writes two columns:

• payer_{type}_rate_anesthesia_cf — converted dollar amount
• payer_{type}_anesthesia_conversion_method — human-readable formula string (e.g., "rate / (base_units + 1)")

Plus the reference column anesthesia_base_units (the CMS base unit weight for the code).

Only applies to payer MRF rates

Hospital MRF anesthesia rates are not converted. If no anesthesia base units entry exists for a code, all conversion columns for that ROID are NULL.