Wednesday, August 11, 2010

Covered anesthesia services - WV medicaid

West Virgina Medicaid

Anesthesia services covered by WV Medicaid include general, regional, and labor epidural. These
services are primarily reimbursed using the American Society of Anesthesiologist’s (ASA) “0” CPT
codes. Supportive services rendered in order to afford the member the necessary anesthesia care are
also covered.

Anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs) are the only providers that
may be reimbursed for general and monitored anesthesia services.

BASE AND TIME UNITS

Two distinct unit values apply to anesthesia services. Base units are defined by the ASA Uniform
Relative Value Guide. These units are part of the procedure and may not be billed separately.
The other value is the time unit. WV Medicaid defines a time unit as 15 minutes which must be
rounded to the nearest whole unit. (Eight minutes or more, round up. Seven minutes or less, round
down.) Only time units may be billed.

Payment is determined by the sum of the ASA base units plus time units multiplied by the anesthesia
conversion factor. There is a limit of 40 units (10 hours) on each anesthesia Zero “0” code, except for
maternity-related anesthesia services. (See Section 519.8.3.) If anesthesia is provided longer than 10
hours, the claim must be billed on paper and submitted with documentation that would justify the
additional anesthesia used.

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