Special Situations for Anesthesia
If two procedures of special unit value are billed, the first procedure will be paid and the second one will deny because the subsequent procedure is included in the primary anesthesia charge.
If two procedures are billed with different unit values, the procedure with the greatest unit value will pay and the other procedure will deny because the subsequent procedure is included in primary anesthesia charge.
The anesthetic agent for nerve blocks (CPT codes 64400-64530) is included in the reimbursement fee for the performance or administration of the nerve block. No additional procedures should be filed for the nerve block medication.
Anesthesia for CAT Scans or MRI/MRA Procedures is not covered for anesthesiologists. The attending/admitting physician is responsible for ordering the necessary measure(s) to ensure the patient is prepared for these tests.
Monitored Anesthesia Care is a covered service.
Medicaid does not cover physical status modifiers.
Qualifying factors may be billed in addition to anesthesia codes if applicable. See Section 38.5.3 for more information.
Standby anesthesia is not payable under Medicaid.
