REIMBURSEMENT FOR ANESTHESIA
Rural Services
Services performed in rural areas will be reimbursed at 12% higher than the regular fee for anesthesia . The higher fee is available only when the anesthesia services are performed in a rural setting. Payment is not based on patient residence.
Basic Value
A Basic Value is assigned for anesthetic management of most surgical procedures and is related to the complexity of the procedure. This basic value includes all usual anesthesia except the time actually spent in anesthesia care and any modifiers. The usual anesthesia included in the Basic Value are the usual pre-operative and postoperative visits, the administration of fluids and/or blood products incident to the anesthesia care and interpretation of non-invasive monitoring.
In computing payment for anesthesia, basic value units for anesthesia procedure codes are “hard coded” in Medicaid’s computer system and are obtained automatically, and do not require any additional billing requirements, other than their “identification” on the claim.
Time Reporting
Time Units will be added to the basic value and modifying units as is customary in the local area. Anesthesia time begins when the anesthesiologist begins to prepare the patient for the induction of anesthesia in the operating room or in an equivalent area and ends when the anesthesiologist is no longer in personal attendance, that is, when the patient may be safely placed under postoperative supervision.
Utah Medicaid’s Time Reporting Policy
Time reporting for Utah Medicaid is computed at the rate of one time unit for each twelve-minute or fraction thereof. Fractions of time are always rounded up to the next full number.
Exampl
60 minutes = 5 time units Time will be calculated as 5 time units
65 minutes = 5.42 time units Time will be calculated as 6 time units
Obstetrical Anesthesia – Time Reporting
Because obstetrical anesthesia is unique and an anesthesiologist may attend more than one patient concurrently under continuous regional anesthesia, there is a reduction in the unit value after the first hour of anesthesia time. For the first hour, 5 time units will be calculated; for the second hour, 2.5 units; for the third and each succeeding hour of anesthesia, 1.25 units. The reduction in unit value affect the following ASA procedure code:
01967 Neuraxial labor analgesia/anesthesia for planned vaginal delivery
When billing obstetrical anesthesia, indicate total time, in minutes. The Medicaid Management Information System (MMIS) will calculate the appropriate reduction in unit value.
