Anesthesia CPT code that require authorization

 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 MedicaidProvider Manual for Physician Services.The anesthesiologist is required to enter the prior authorization number obtained by the surgeon for the CPT code when billing ... Read More

Payment rules

PAYMENT AND REIMBURSEMENT – Anesthesia Payment at Medically Supervised RateOnly 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 ... Read More

Concurrent Medically Directed Anesthesia Procedures

Concurrent Medically Directed Procedures Concurrency is defined with regard to the maximum number of procedures that the physician is medically directing within the context of a single procedure and whether the other procedures overlap each other. Concurrency is not dependent on each of the cases involving a Medicare patient. For example, if an anesthesiologist directs ... Read More

Anesthesia billing modifier QK, QX, QY, QZ, QS, AND G8,G9

Billing Modifiers The following modifiers are used when billing for anesthesia services: • QX – Qualified nonphysician anesthetist with medical direction by a physician. • QZ – CRNA without medical direction by a physician. • QS – Monitored anesthesiology care services (can be billed by a qualified nonphysician anesthetist or a physician). • QY – ... Read More

Anesthesia payment reimbursment tips

PAYMENT AND REIMBURSEMENT – Anesthesia 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 ... Read More

Pre and post anesthetic service and eligible providers

Pre-anesthetic Evaluations and Post-operative Visits MHCP uses the CMS list of base values, which were adopted from the relative base values established by the ASA. The base value for anesthesia services includes usual pre-operative and post-operative visits. No separate payment is allowed for the pre-anesthetic evaluation regardless of when it occurs unless the recipient is ... Read More

Monitored Anesthesia Care (MAC)

Monitored anesthesia care is a specific anesthesia service in which an anesthesiologist or CRNA has been requested to participate in the care of a patient undergoing a diagnostic or therapeutic procedure. Monitored anesthesia care includes all aspects of anesthesia care: a pre-procedure visit, intraprocedure care and postprocedure anesthesia management. During monitored anesthesia care, the anesthesiologist ... Read More

Conscious Sedation and Deep Sedation

Conscious Sedation The intent of conscious sedation is for the patient to remain conscious and able to communicate during the entire procedure. The patient retains the ability to independently and continuously maintain a patent airway and respond appropriately to physical stimulation and/or verbal command. Conscious sedation includes performance and documentation of pre- and post sedation ... Read More

Billing for Anesthesia Services

Claims Documentation Requirements  Submit claims for anesthesia services on the CMS-1500 claim form or the electronic equivalent. Use specific CPT American Society of Anesthesiology (ASA) anesthesia codes or surgical codes with the appropriate anesthesia modifier. For authorized surgical services, MHCP prefers that anesthesia services are billed using surgical procedure codes with the appropriate anesthesia modifier. ... Read More

Anesthesia provider types

Anesthesiology: The practice of medicine dedicated to the relief of pain and total care of the surgical patient before, during and after surgery.  Anesthesiologist: A physician who specializes in anesthesiology and is board certified as an anesthesiologist.  Certified Registered Nurse Anesthetist (CRNA): An advance practice registered nurse. CRNAs are registered nurses with a baccalaureate degree ... Read More