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 Medicaid Provider Manual for Physician Services.
When Is Authorization Required?
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 ASA procedure 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:
- 1The procedure was performed in a life-threatening or justifiable emergency situation.
- Medicaid is responsible for the delay in prior authorization.
- 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.
List With CPT Codes That May Require Prior Authorization
- CPT 00402: Anesthesia for reconstructive breast procedures (reduction, augmentation, muscle flaps).
- CPT 00580: Anesthesia for heart transplant or heart-lung transplant.
- CPT 00796: Liver transplant (recipient).
- CPT 00840: Anesthesia for intraperitoneal procedures in lower abdomen (hysterectomy and sterilization).
- CPT 00846: Anesthesia for radical hysterectomy.
- CPT 00848: Anesthesia for pelvic exenteration,
- CPT 00855: Anesthesia for cesarean hysterectomy
- CPT 00922: Anesthesia for seminal vesicles
- CPT 00926: Male, external genitalia; radical orchiectomy, inguinal
- CPT 00928: Anesthesia for inguinal orchiectomy
- CPT 00932: Anesthesia for complete amputation of penis
- CPT 00934: Anesthesia for radical amputation of penis with bilateral inguinal lymphadenectomy
- CPT 00936: Anesthesia for radical amputation of penis with bilateral inguinal and iliac lymphadenectomy
- CPT 00940: Anesthesia for abortion procedures
- CPT 00944: Anesthesia for vaginal hysterectomy
- CPT 00952: Anesthesia for hysteroscopy