Ventilator Management anesthesia service payment from BCBS

Anesthesia Payment & Billing Information – BCBS

Ventilator Management in Conjunction with Anesthesia Services 94656 and 94657:

Ventilation management billed on the same day as an anesthesia procedure is part of the global anesthesia service for the first 24 hours after anesthesia induction and therefore it is not billable.
If procedure code 94656 is reported on the same day, on the same patient, by the same provider as an anesthesia procedure, the ventilation management service will be denied.

Subsequent ventilation management (94657) billed on the same day as an evaluation and management service is considered part of the evaluation and management service and is not payable separately even if the evaluation and management service is billed with modifier 25. If the patient develops unusual postoperative respiratory problems that require reintubation and/or ventilation management, the physician should report the service with critical care or the appropriate evaluation and management code(s).

Daily Hospital Management of Epidural or Subarachnoid Continuous Drug Administration – 01996 :

Procedure code 01996 is not allowed on the day of the operative procedure. Only one (1) unit of service (not base units) will be allowed each day, starting on the first day following the surgical procedure, up to a maximum of three (3) days.

62310, 62311, 62318 and 62319 :

HMO Blue Texas and Blue Cross and Blue Shield of Texas have determined that these procedures are surgical services and claims should reflect a type of service of 2. These codes will be reimbursed at the current maximum allowable as determined by HMO Blue Texas and Blue Cross and Blue Shield of Texas. Claims filed with CPT anesthesia procedure code 01991 or 01992 and type of service of 7 will be reimbursed on time and points methodology.

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