Modifier for Medicaly Directed / Suervised Anesthesia services

Medically Directed / Supervised MODIFIER MODIFIER NARRATIVE PROVIDER TYPE ADDITIONAL MEDICARE INFORMATION AD  Medical Supervision by a physician, more than four (4) concurrent anesthesia procedures Anesthesiologist Allow three (3) base units, and one (1) additional base unit when it is demonstrated that the physician was present at the induction QK Medical direction of two, three, ... Read More

Medicare reimbursement formula for different type of Anesthesia

GENERAL ANESTHESIA Code Set Medicare uses anesthesia codes and base values adopted from the list values established by the American Society of Anesthesiologists (ASA). General Information Anesthesia administration includes the following services: ** Preoperative and postoperative visits ** Anesthesia care during the procedure ** Administration of fluids and blood ** Usual monitoring (e.g., ECG, temperature, ... Read More

Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits

The CLIA regulations require a facility to be appropriately certified for each test performed. To ensure that Medicare and Medicaid only pay for laboratory tests in a facility with a valid, current Clinical Laboratory Improvement Amendments (CLIA) certificate, laboratory claims are currently edited at the CLIA certificate level. The codes that are considered a laboratory ... Read More

CPT CODE G0105, G0121 Medicare update

Anesthesia Furnished in Conjunction with Colonoscopy  Section 4104 of the Affordable Care Act defined the term “preventive services” to include “colorectal cancer screening tests” and as a result it waives any coinsurance that would otherwise apply under Section 1833(a)(1) of the Act for screening colonoscopies. In addition, the Affordable Care Act amended Section 1833(b)(1) of ... Read More

Medicare participation announcement

View the Centers for Medicare & Medicaid Services (CMS) Announcement about Medicare Participation for Calendar Year 2015. Why participate? Medicare fee schedule amounts are 5% higher if you participate. Included in the Medicare Participating Directory (MEDPARD). Participants have “one stop” billing for beneficiaries who also have Medigap coverage and who assign their Medigap payments to ... Read More

EMPIRE MEDICARE’S covered diagnosis for anesthesia

 EMPIRE MEDICARE’S POLICY FOR ANESTHESIA AND GASTORINESTINAL ENDOSCOPY ICD-9 CM Diagnosis Codes that Support Medical Necessity It is not enough to link the procedure code to a correct, payable ICD-9-CM diagnosis code. The diagnosis or clinical suspicion must be present for the procedure to be paid. Below are diagnosis codes that support medical necessity. ICD-9 ... Read More


EMPIRE MEDICARE’S POLICY FOR ANESTHESIA AND GASTORINESTINAL ENDOSCOPY Patients undergoing gastrointestinal endoscopy receive medications for anxiety, discomfort and anesthesia, as well as monitoring during the procedure.CPT Codes00740       Anesthesia for upper gastrointestinal endoscopic procedures00810       Anesthesia for intestinal endoscopic proceduresHCFA’s National PolicyAnesthesia by the performing surgeon is not separately reimbursable to the surgeon.Indications ... Read More