CPT codes

Patient Controlled Analgesia and Intractable Pain and Epidural Catheters

by Niels
Patient Controlled Analgesia Patient controlled analgesia (PCA) services are reimbursable when they are administered by an anesthesiologist and are performed for the control of postoperative pain. A separately identifiable physician-recipient encounter should be reflected in the medical record documentation. PCA pumps are usually administered through an intravenous (IV) line or the PCA pump is connected ... Read More

How to bill anesthesia

by Niels
Medi-Cal has not adopted the “qualifying circumstances” codes (99100 – 99140).  Claims submitted with these codes will be denied or returned to the provider for correction. Billing Anesthesia Services Anesthesia services (CPT-4 codes 00100 – 01999) are reimbursed when medically necessary.  To bill for anesthesia services, use the five-digit CPT-4 code applicable to the procedure ... Read More

Anesthesia consultation

by Niels
Consultations A consultation for anesthesia performed on the day of or days before a procedure is considered part of the global procedure and is not a separately reimbursable item. There are two exceptions to the above as outlined below. — A recipient with chronic intractable pain receives a consult from an anesthesiologist for the chronic ... 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

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

Special Situations for Anesthesia

by Niels
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 ... 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

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

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