Oregon Administrative Rules
Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION
Division 53 - HEALTH BENEFIT PLANS
Section 836-053-1615 - Anesthesia-related claims
Current through Register Vol. 63, No. 9, September 1, 2024
(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.
Statutory/Other Authority: ORS 743B.287
Statutes/Other Implemented: ORS 743B.287