Month: June 2010

Medicaid Enrollment – Anesthesiology

by Niels
Anesthesiology – Medicaid Administration of anesthesia is a covered service when administered by or directed by a duly licensed physician for a medical procedure that is covered by Medicaid. Enrollment EDS enrolls anesthesiologists, Certified Registered Nurse Anesthetists (CRNA) and Anesthesiology Assistants (AA) and issues provider contracts to applicants who meet the licensure and/or certification requirements ... Read More

Global Anesthesia Definition

by Niels
Global Anesthesia Definition The Agency has identified certain procedures to be included in the global payment for the anesthesia services. These procedures include but are not limited to the following: general anesthesia, regional anesthesia, local anesthesia, supplementation of local anesthesia, and other supportive treatment administered to maintain optimal anesthesia care deemed necessary by the anesthesiologist ... Read More

Benefits and Limitations

by Niels
Benefits and Limitations This section describes program-specific benefits and limitations. Verifying Recipient Eligibility, for general benefit information and limitations. Administration of anesthesia is a covered service when administered by or directed by a duly licensed physician for a medical procedure that is covered by Medicaid. Medical direction by an anesthesiologist of more than four Certified ... Read More

when to get prior authorization – Medicaid insurance

by Niels
PRIOR AUTHORIZATION Anesthesiologists are not required to request prior authorization (PA) from Medicaid. However, for any anesthesia code on the list titled ASA Codes Associated With CPT Codes W hich Require Prior Authorization, included in this section, the anesthesiologist is required to obtain the PA number for the CPT code from the surgeon and enter ... Read More

Payment for multiple procedure – Utah Medicaid

by Niels
MULTIPLE PROCEDURES – Utah Medicaid – Anesthesiology When multiple procedures are performed during a single anesthetic administration, Medicaid’s policy is to pay the basic value for only one anesthesia procedure. It is suggested that providers select the ASA procedure code with the highest basic value. Obstetrical anesthesia is an exception to this policy. Multiple Obstetrical ... Read More

CRNA covered CPT codes

by Niels
CPT LIST OF CODES COVERED FOR PROVIDER TYPE 38, CRNA00010 upto 00540 00100 ANESTHESIA PROCEDURES SALIVARY GLANDS,INCL BIOPSY 00102 ANESTHESIA PROCEDURES PLASTIC REPAIR OF CLEFT LIP 00103 ANESTHESIA FOR RECONSTRUCTIVE PROCEDURES OF EYELID 00104 ANESTHESIA FOR ELECTROCONVULSIVE THERAPY 00120 ANESTH EXTERNAL, MIDDLE, INNER EAR INC BIOPSY;NOS 00124 ANESTH EXTRNL,MIDDLE,INNER EAR INC BIOPSY;OTOSCOPY 00126 ANES XTRNL,MIDDLE,INNER ... Read More

CPT LIST OF CODES COVERED FOR PROVIDER TYPE 38, CRNA

by Niels
CPT LIST OF CODES COVERED FOR PROVIDER TYPE 38, CRNA 00541 upto 00952 00541 ANESTH THORACOTOMY PROC,UTILIZ 1 LUNG VENTILATION 00542 THORACOTOMY(LUNGS,PLEURA,DIAPHRAGM);DECORTICATION 00546 THORACOTOMY;PULMONARY RESECTION WITH THORACOPLASTY 00548 THORACOTOMY;INTRATHORACIC PROC TRACHEA & BRONCHI 00550 ANESTHESIA FOR STERNAL DEBRIDEMENT 00560 HEART,PERICARDIUM,GREAT VESSELS,W/O PUMP OXYGENATR 00561 ANESTH PROC ON HEART SURG W/PUMP OXYGEN < AGE 1 00562 HEART,PERICARDIUM,GREAT ... Read More

what is qualifying circumstances

by Niels
Qualifying circumstances. Anesthesia services, which are provided under particularly difficult circumstances, may warrant additional reimbursement for unit values based on unusual events. This subsection includes a list of important qualifying circumstances that impact the anesthesia service provided. These procedures are not reported alone but are reported as additional procedure numbers qualifying an anesthesia procedure for ... Read More

How payment has been calculated for anethesia services

by Niels
Reimbursement for anesthesia services shall be made at the provider’s usual charge or the anesthesia reimbursement allowance (ARA) listed in Part A, Section X in this manual. a. Methodology for calculating the anesthesia reimbursement allowance (ARA) for procedures that are listed basic value (BV) + time (TM). (1) Select the applicable anesthesia procedure code and ... Read More

Anesthesia services – Reimbursement – Worker compensation

by Niels
Reimbursement for anesthesia services shall be made to a physician or certified registered nurse anesthetist (CRNA). 1. Reimbursement shall be based on application of the following values, physical status modifiers and certain qualifying circumstances. a. Basic value (BV) or base unit. (1) The usual preoperative and postoperative visits, the anesthesia care during the procedure, the ... Read More