Monday, August 9, 2010

Anesthesia Services Billing Instructions - How to fill the claim form



Policy
The following provider types can bill for anesthesia services:
�� Physician, M.D., Osteopath (provider type 20)
�� Certified RN Practitioner (provider type 24)
�� Nurse Anesthetists (provider type 72)

 This policy covers base units, reportable anesthesia time and appropriate billing.

 

Covered Services and Rates

Covered services and rates are listed on the Division of Health Care Financing and Policy website (on http://dhcfp.nv.gov, select “Rates” from the DHCFP Index, then scroll down and click “Anesthesiology Unit Values”).

Prior Authorization

Anesthesia itself does not require prior authorization; however, prior authorization may be required for the related surgical procedure or service.


Time-Based Units
Medicaid payments for anesthesiology are based on the Centers for Medicare and Medicaid Services (CMS) base units.

Fifteen minutes equals one unit. A period less than a unit should be rounded up to the next unit.For example, 128 minutes is billed as 9 units (8 units for the first 120 minutes and 1 additional unit for the remaining 8 minutes).

Completing the Claim Form
The following instructions are specific to anesthesia services and must be used in conjunction with the complete CMS-1500 Claim Form Instructions website.

Field 19: When billing a time-based code, enter the total minutes of reportable anesthesia
time in Field 19.

Field 24D: On the bottom, white half of the claim line, enter one 5-digit CPT code. Nevada Medicaid does not reimburse separately for physical status modifiers or qualifying circumstances.

Field 24G:
In the bottom, white half of the claim line, enter the number of days or the number of units being billed.

  �� When using a time-based code, enter the number of reportable anesthesia time units; do not add base units or modifier units to the time units.

  �� When using an occurrence-based code, enter a “1” for each occurrence.
The following codes are paid per occurrence: 01953, 01967, 01968, 01969 and 01996.

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