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TO:                 ANESTHESIA PROVIDERS

 

FROM:           PAUL SWATSENBARG, Deputy Administrator

 

Medicaid policy for reimbursement of anesthesia services has been changed to the following: 

 

For dates of service on or after January 1, 2002, Medicaid will reimburse one provider a base-rate plus time per day.  However, when an anesthesia service is repeated by the same physician in the same day, a payment for the additional session may be billed using the anesthesia code with the 76 modifier.  Medicaid considers a second session to be when the patient is returned to surgery after spending time in another unit of the hospital. 

 

Examples:

 

·        If the provider begins the procedure with a block, and then changes to general anesthesia, Medicaid considers this to be one session.  Reimbursement would be one base-rate and the time involved for both types of anesthesia. 

 

·        If one procedure is performed, such as a delivery, and then another separate procedure is performed later on the same day, for example a tubal ligation, then two sessions have occurred and reimbursement would be for two base-rates and the time for both sessions. 

 

·        If the patient has a delivery or surgery, in which the same day complications and/or an emergency arises from the surgery, then two sessions have occurred and are covered. 

 

·        If one provider begins the procedure and, for some reason, another provider completes the procedure, the first provider would submit for the base-rate and ALL of the time performed by both providers.  It is the responsibility of the first provider to compensate the second provider (similar to Locum Tenens).

 

Any questions regarding this Information Release should be directed to Colleen Osborn at (208) 334-5795 ext. 16.  Thank you for your continued participation in the Idaho Medicaid Program.