Anesthesia News
January 23, 2012 – Effective February 1, 2012, BCBSNEPA will add new policy statements for manipulation under anesthesia.  1. MUA of the knee and shoulder may be considered medically necessary only after adequate trial of conservative measures (physical therapy and joint injections) have failed to restore the range of motion and relieve pain, for [...]
January 23, 2012 – Horizon BCBSNJ is reminding all providers of their anesthesia guidelines for participating and non-participating providers. Their reimbursement rate for the overall anesthesia service(s) provided will not exceed 100 percent of the applicable Horizon BCBSNJ fee schedule.  Eligible anesthesia services provided by a physician or a Certified Nurse Anesthetist will be [...]
January 23, 2012 – Effective January 1, 2012, pain management procedures (paravertebral facet joint injections, transforaminal epidural injections, epidural injections) have been added to all Medicare Advantage products’ precertification requirements in all settings.
December 30, 2011 – Currently Highmark BCBS applies anesthesia base units to procedure codes to determine reimbursement and obtains these units from the American Society of Anesthesiologists (ASA). Beginning April 2, 2012, Highmark will begin to use CMS’ base units for reimbursement determination. For the most part, CMS anesthesia base units are the same as [...]
November 17, 2011 – Effective in early December 2011, UNC’s anesthesia policy will undergo cosmetic and verbiage changes to more clearly state UHC’s reimbursement parameters for anesthesia services. The substance and intent of the policy will not change and claims will continue to be paid in the same manner as they were in 2011.
September 21, 2011 – Effective November 13, 2011, reimbursement for any procedure with the following modifiers will be at 50%. Current 50% reimbursement for anesthesia procedures reported with these modifiers will not change. Modifiers Used By Anesthesiologists Modifier QK Medical direction (supervision) of two, three or four concurrent anesthesia procedures Modifier QY Anesthesiologist medically directs [...]
August 17, 2011 – The current Anesthesia Policy states that when multiple surgical procedures are performed during a single anesthesia administration, only the anesthesia management service code (CPT® codes 00100-01999 excluding 01996) with the highest basic value should be reported. When subsequent anesthesia management services are necessary for a patient returning to the operating room [...]
July 20, 2011 – Clarifications and Revisions to anesthesia policies were released by UHC and will be implemented in the third quarter of 2011. Clarifications for reimbursement of CPT code 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration) Language that describes pain management services and daily hospital management by the surgeon or [...]
June 16, 2011 – On May 20, CMS released CR Transmittal R2222CP, stating that effective October 3, 2011, rural hospitals and CAHs(CriticalAccessHospital) will be able to receive the CRNA pass-through payments. Under this transmittal, these hospitals will be able to employ CRNAs and write-off their costs on the hospital’s cost reports, and Medicare will reimburse [...]
May 19, 2011 – Highmark currently applies anesthesia base units, obtained from the American Society of Anesthesiologists (ASA), to procedure codes to determine reimbursement. The Centers for Medicare and Medicaid Services (CMS) also assigns anesthesia base units to procedure codes. For the most part, CMS anesthesia base units are the same as the ASA’s; however, [...]
May 19, 2011 – It has not been the policy of Oxfordhealth to directly credential anesthesiologists because most anesthesiology services were performed in the hospital. Recent medical trends have shown a significant increase in office-based anesthesia services, particularly in New York. As a result, Oxford is expanding their credentialing process to include anesthesiologists who perform [...]
May 19, 2011 – Effective July 1, 2011, anesthesia time units reported in minutes will be divided by fifteen (15) minutes and rounded to one decimal place (e.g., 16 minutes =1.1 units), replacing the current process of rounding to the next whole number. (e.g., 16 minutes = 2 units) This change is reported in Claim [...]
April  20, 2011 – At the beginning of 2011, Horizon BCBS updated their system to recognize the following modifiers as informational only. These modifiers must be used in the second modifier position, in conjunction with an anesthesia pricing modifier in the first modifier position. These modifiers do not affect reimbursement.  QS– Monitored anesthesia care [...]
