Thursday, June 16, 2016

BCBS claim filing limit for Anesthesia claims

Claim Filing
Effective for dates of service on or after January 1, 2014, Blue Cross requires claims for anesthesiologists, CRNAs and AAs to be billed under the name and National Provider Identifier (NPI) of the provider who  actually rendered the service. Blue Cross does not recognize “incident to” billing for anesthesia services. All providers should render services based on the scope of their particular license and requirements of the State of Alabama. Practitioners (anesthesiologists, CRNAs and AAs) must each file for the professional anesthesia services they performed electronically on the electronic 837 Professional 5010. For CRNA services performed on or after January 1, 2014, services will no longer be reimbursed through the hospital Blue Cross Cost Study. Both CRNA costs and charges should be excluded from the costs and charges reported in the hospital Blue Cross Cost Study.


Coding

Qualified anesthesia providers may bill directly for services using CPT anesthesiology codes 00100 – 01999. While some surgical CPT codes are appropriate to use when billing anesthesia services (e.g., CPT code 36620) the majority of anesthesia services should be billed using codes in the range of 00100 – 01999.


Base Units
The base unit is the value assigned to each CPT code and includes all usual services except the time actually spent in anesthesia care. Pre-operative and post-operative visits are usually included. When multiple anesthesia services are performed, only the anesthesia services with the highest base unit value should be filed with total time for all services reported on the highest base unit value. The base units value should never be entered in the “units” field when filing claims. Effective for dates of service on or after January 1, 2014, Blue Cross will utilize the Centers for Medicare & Medicaid Services (CMS) base unit values.

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