Anesthesiologists are NOT required to request prior authorization. The surgeon must obtain prior authorization when required for procedures identified in the Medical and Surgical Procedure Code List included with the Utah MedicaidProvider Manual for Physician Services.
The anesthesiologist is required to enter the prior authorization number obtained by the surgeon for the CPT code when billing an ASA code related to a CPT procedure for a hysterectomy, sterilization or abortion. The ASAprocedure codes listed below are associated with surgical codes that may require prior authorization by Medicaid.
If federal requirements for obtaining prior authorization for a hysterectomy, sterilization or abortion are not met,Medicaid cannot reimburse either the physician or the anesthesiologist. Exceptions (to the requirement that the surgeon obtain Prior Authorization before the procedure is performed) canbe considered ONLY under one of the following circumstances:
1. The procedure was performed in a life-threatening or justifiable emergency situation.2. Medicaid is responsible for the delay in prior authorization.3. The patient is retroactively eligible for Medicaid.
Retroactive authorization for services related to these exceptions may be granted “after-the-fact” with appropriate documentation and review. If approved, the associated ASA code may also be reimbursed.
For additional information about the prior authorization process, refer to the Utah Medicaid Provider Manual,SECTION I, or contact Medicaid Information.
ASA Codes Associated with CPT Codes That May Require Prior Authorization
00402 Anesthesia for reconstructive breast procedures (reduction, augmentation, muscle flaps)
00580 Anesthesia for heart transplant or heart-lung transplant
00796 Liver transplant (recipient)
00840 Anesthesia for intraperitoneal procedures in lower abdomen (hysterectomy and sterilization)
00846 Anesthesia for radical hysterectomy
00848 Anesthesia for pelvic exenteration
00855 Anesthesia for cesarean hysterectomy
00922 Anesthesia for seminal vesicles
00926 Male, external genitalia; radical orchiectomy, inguinal
00928 Anesthesia for inguinal orchiectomy
00932 Anesthesia for complete amputation of penis
00934 Anesthesia for radical amputation of penis with bilateral inguinal lymphadenectomy
00936 Anesthesia for radical amputation of penis with bilateral inguinal and iliac lymphadenectomy
00940 Anesthesia for abortion procedures
00944 Anesthesia for vaginal hysterectomy
00952 Anesthesia for hysteroscopy