State Law

Oregon Admin. Rules-Insurance Regulation-Chapter 836-Division 53. Health Benefit Plans

08/20/2023 Oregon Section 836-053-1615

Anesthesia-related claims

OON-Payment Issues

(1) Out-of-network reimbursement for anesthesia-related claims, including obstetric anesthesia claims, shall be no less than:

(Base units + Time units + Physical status units) x Anesthesia Conversion factor x Q modifier adjustment x CPI adjustment

(2) Out-of-network reimbursement for an anesthesia-related claim that does not have a number of base units published in the CY 2018 Physician Fee Schedule Final Rule shall be reimbursed at a rate calculated with a number of base units agreed upon in good faith by the insurer and provider to be usual and customary for in-network commercial claims, using best efforts to establish a rate within a reasonable amount of time.