Anesthesia payment

Concurrent Medically Directed Anesthesia Procedures payment

by Niels
Payment Conditions for Anesthesiology Services Definition of Concurrent Medically Directed Anesthesia Procedures Concurrency is defined with regard to the maximum number of procedures the anesthesiologist is medically directing within the context of a single procedure and whether these other procedures overlap each other. Concurrency is not dependent on each of the cases involving a Medicare ... Read More

Anesthesia billing payment – Medical direction CRNA

by Niels
Payment Conditions for Anesthesiology Services Medical Direction For a single anesthesia case involving both a physician medical direction service and the service of the medically directed CRNA, the payment amount for each service may be no greater than 50 percent of the allowance. The total payment for both may not exceed the amount that would ... Read More

Anesthesia payment when personally performed services

by Niels
Payment Conditions for Anesthesiology Services Personally Performed Services  The physician personally performed the entire anesthesia service alone.  The physician is involved with one anesthesia case with a resident and the physician is a teaching physician as defined in the IOM, Pub.100-04, Chapter 12, Section 100 at http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf.  The physician is involved in ... Read More

General Anesthesia Reimbursement Limitations – Medical insurance

by Niels
Duplicate Billing Not Allowed Medi-Cal policy prohibits payment for duplicate services and/or billings.  The second and subsequent claims for anesthesia services billed for the same date of service, the same recipient and the same procedure submitted by the same or different providers will be denied with RAD code 328, “Another procedure with an anesthesia modifier ... Read More

Payment for Medically directed and non medically directed rate

by Niels
PAYMENT AND REIMBURSEMENT Payment at Personally Performed Rate The fee schedule payment for a personally performed procedure is based on the full base unit and one time unit per 15 minutes of service if the physician personally performed the entire procedure. Modifier AA is appropriate when services are personally performed. Payment at Medically Directed Rate ... Read More

Insurance Payment rule for Anesthesia Medically supervised rate

by Niels
Payment at Medically Supervised Rate Only three (3) base units per procedure are allowed when the anesthesiologist is involved in rendering more than four (4) procedures concurrently or is performing other services while directing the concurrent procedures. An additional time unit can be recognized if the physician can document he/she was present at induction. Modifier ... Read More

Separately Reimbursable Anesthesia Services

by Niels
Medi-Cal insurance separately reimburses for the following anesthesia services. CPT-4 Code    Definition 36555    Insertion of non-tunneled centrally inserted central venous catheter; under 5 years of age 36556    Age 5 years or older 36568    Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; under 5 years of age 36569        Age 5 ... 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

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

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