MODERATE SEDATION POLICY

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "MODERATE SEDATION POLICY"

Transcription

1 MODERATE SEDATION POLICY REIMBURSEMENT POLICY Policy Number: ANESTHESIA T0 Effective Date: April, 206 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION... OVERVIEW... REIMBURSEMENT GUIDELINES... DEFINITIONS... QUESTIONS AND ANSWERS... ATTACHMENTS... RESOURCES/REFERENCES... POLICY HISTORY/REVISION INFORMATION... Page 2 Related Policy: Supply Policy The services described in Oxford policies are subject to the terms, conditions and limitations of the Member's contract or certificate. Unless otherwise stated, Oxford policies do not apply to Medicare Advantage enrollees. Oxford reserves the right, in its sole discretion, to modify policies as necessary without prior written notice unless otherwise required by Oxford's administrative procedures or applicable state law. The term Oxford includes Oxford Health Plans, LLC and all of its subsidiaries as appropriate for these policies. Certain policies may not be applicable to Self-Funded Members and certain insured products. Refer to the Member's plan of benefits or Certificate of Coverage to determine whether coverage is provided or if there are any exclusions or benefit limitations applicable to any of these policies. If there is a difference between any policy and the Member s plan of benefits or Certificate of Coverage, the plan of benefits or Certificate of Coverage will govern. APPLICABLE LINES OF BUSINESS/PRODUCTS This policy applies to Oxford Commercial plan membership. Note: While precertification is not required for moderate sedation, it may be required for the therapeutic and/or diagnostic procedures for which sedation is being provided. APPLICATION This reimbursement policy applies to services reported using the UB-0 claim form, the 00 Health Insurance Claim Form (a/k/a CMS-00), or their electronic equivalents or their successor forms. This policy applies to all network and non-network providers, including hospitals, ambulatory surgical centers, physicians and other qualified health care professionals including, but not limited to, non-network authorized and percent of charge contract physicians and other qualified health care professionals. OVERVIEW Current Procedural Terminology (CPT ) defines Moderate (conscious) Sedation as a drug induced depression of consciousness during which patients respond purposefully to verbal

2 commands, either alone or accompanied by light tactile stimulation. In addition, no interventions are required to maintain a patent airway and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. Moderate Sedation does not include Minimal Sedation (anxiolysis), deep sedation, or monitored anesthesia care (CPT codes ). Moderate Sedation services reported by the same physician, hospital, ambulatory surgical center, or other qualified health care professional reporting the diagnostic or therapeutic procedure, are separately reimbursable services when submitted under CPT codes except when reported with the procedures noted below. In a facility setting, Moderate Sedation services performed by a second physician, hospital, ambulatory surgical center or other qualified health care professional are separately reimbursable services when submitted under CPT codes In a non-facility setting, CPT codes will not be reimbursed when the same physician, hospital, ambulatory surgical center or other qualified health care professional also reports a code listed in Appendix G of the CPT codebook. Note: Based on their intended use, Moderate Sedation codes would not be reported with diagnostic or therapeutic procedures. Oxford's reimbursement policy for Moderate Sedation services is based on methodologies used and recognized by the Centers for Medicare and Medicaid Services (CMS) National Correct Coding Initiative (NCCI) edits and Policy Manual, and CPT codebook guidelines. For purposes of this policy, same physician, hospital, ambulatory surgical center or other qualified health care professional is defined as the same physician, hospital, ambulatory surgical center or other qualified health care professional rendering health care services reporting the same Federal Tax Identification number. REIMBURSEMENT GUIDELINES Attending Physician (993-99) Oxford will allow separate reimbursement for Moderate Sedation services reported as CPT codes when provided by the Same Physician, hospital, ambulatory surgical center, or other qualified health care professional reporting the diagnostic or therapeutic procedure except when reported with:. Procedures listed in Appendix G of the CPT book 2. Anesthesia procedures (CPT codes ) 3. CPT and HCPCS codes that are part of CMS NCCI edits These procedures include Moderate Sedation as an inherent part of providing the service. Refer to the list below for a comprehensive listing of the non-anesthesia procedures that include Moderate Sedation and for which CPT codes will not be considered separately. Procedures that include Moderate Sedation codes (993-99) Note: Procedure codes that are listed in Appendix G of the CPT book that are also identified on the National Physicians Fee Schedule (NPFS) as Status B are addressed in the B Bundle Codes Policy. Second Physician ( ) Moderate Sedation services performed by a second physician, hospital, ambulatory surgical center, or other qualified health care professional (who is not performing the diagnostic or therapeutic procedure that the sedation supports), should be reported as CPT codes Reimbursement of CPT codes based on the place of service is as follows: 2

3 Non-facility setting According to the AMA When moderate sedation is performed in the non-facility setting, the efforts of the second physician are not reported with the codes in Appendix G because moderate sedation is included in these codes. Therefore, it would not be appropriate to separately report for moderate sedation. Based on AMA guidelines, Oxford will reimburse CPT codes in a non-facility setting except when a procedure code listed in Appendix G of the CPT codebook is also reported on the same date of service by the same physician or other qualified health care professional. Facility setting Moderate Sedation services reported as CPT codes that are performed by a second physician, hospital, ambulatory surgical center, or other qualified health care professional in a facility place of service (see listing below) are eligible for reimbursement. For purposes of this policy a facility place of service would include any of the following locations: 9 Off Campus-Outpatient Hospital 2 Inpatient Hospital 22 On Campus-Outpatient Hospital 23 Emergency Room-Hospital 2 Ambulatory Surgical Center 26 Military Treatment Facility 3 Skilled Nursing Facility 3 Hospice Ambulance - Land 2 Ambulance - Air or Water Inpatient Psychiatric Facility 2 Psychiatric Facility - Partial Hospitalization 3 Community Mental Health Center 6 Psychiatric Residential Treatment Center 6 Comprehensive Inpatient Rehabilitation Facility For additional information, refer to the Questions and Answers section, Q&A # and #3. Drug Reimbursement The cost of the drug used in Moderate Sedation, if supplied by the physician in a location other than inpatient/outpatient hospital, emergency room or ambulatory surgical center, is reimbursable at the appropriate fee schedule or contracted rate. For additional information on drugs supplies in an inpatient/outpatient hospital, emergency room or ambulatory surgical center, refer to the Supply Policy. The Current Procedural Terminology (CPT ) codes and Healthcare Common Procedure Coding System (HCPCS) codes listed in this policy are for reference purposes only. Listing of a service code in this policy does not imply that the service described by this code is a covered or noncovered health service. Coverage is determined by the member specific benefit document and applicable laws that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or guarantee claims payment. Other policies and coverage determination guidelines may apply. This list of codes may not be all inclusive. CPT Code 993 Description ) provided by the same physician performing the diagnostic or consciousness and physiological status; under years of age, first 30 minutes intra-service time 3

4 CPT Code Description ) provided by the same physician performing the diagnostic or consciousness and physiological status; age years or older, first 30 minutes intra-service time ) provided by the same physician performing the diagnostic or consciousness and physiological status; each additional minutes intra-service time (List separately in addition to code for primary service) ), provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; under years of age, first 30 minutes intra-service time ), provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; age years or older, first 30 minutes intra-service time ), provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; each additional minutes intra-service time (List separately in addition to code for primary service) CPT is a registered trademark of the American Medical Association. DEFINITIONS Minimal Sedation: Minimal Sedation (anxiolysis) is a drug-induced state during which patients respond normally to verbal commands. Although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are unaffected. Moderate Sedation: Moderate (conscious) Sedation is a drug induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. Moderate Sedation does not include Minimal Sedation (anxiolysis), deep sedation, or monitored anesthesia care (CPT codes ). Same Physician, Hospital, Ambulatory Surgical Center, or Other Qualified Health Care Professional: The same physician, hospital, ambulatory surgical center or other qualified health care professional rendering health care services reporting the same Federal Tax Identification number. QUESTIONS AND ANSWERS Q: A second physician has rendered Moderate Sedation in a non-facility setting for a procedure listed in Appendix G of the CPT codebook reported by the attending physician. Will the second physician s services be separately reimbursed? A: No. When Moderate Sedation is performed in the non-facility setting, the efforts of the second physician are not reported with the codes in Appendix G because Moderate Sedation is included in these codes. In a non-facility setting the second physician is considered the trained observer, and should be reimbursed by the attending physician.

5 Q2: In the policy overview it states: Moderate Sedation does not include Minimal Sedation (anxiolysis). What are some examples of Minimal Sedation? A2: According to the report titled Practice Guidelines for Sedation and Analgesia by Non- Anesthesiologists (obtained from the ASA website), "Examples of minimal sedation include peripheral nerve blocks, local or topical anesthesia, and either () less than 0% nitrous oxide (N2O) in oxygen with no other sedative or analgesic medications by any route, or (2) a single, oral sedative or analgesic medication administered in doses appropriate for the unsupervised treatment of insomnia, anxiety, or pain." Q3: Why would it be appropriate to report CPT codes for an Appendix G procedure when performed in a facility place of service? A3: According to the AMA, the provision of sedation by a second provider would not be the normal course of action and that implies a different intensity of work for these services than would be the case when it is inherent to the procedure. This work would properly be performed in a facility, not a non-facility, place of service. ATTACHMENTS Procedures that include Moderate Sedation Codes This comprehensive list identifies the codes contained in Appendix G of the CPT book and codes that are part of CMS NCCI edits for procedures that include Moderate Sedation services. The codes on this list do not allow separate reimbursement for Moderate Sedation codes RESOURCES/REFERENCES The foregoing Oxford policy has been adapted from an existing UnitedHealthcare national policy that was researched, developed and approved by UnitedHealthcare Payment Policy Oversight Committee. [20R003A]. Centers for Medicare and Medicaid Services, CMS Manual System and other CMS publications and services. 2. Centers for Medicare and Medicaid Services, National Correct Coding Initiative (NCCI) publications. 3. American Medical Association, Current Procedural Terminology (CPT ) and associated publications and services.. Publications and services of the American Society of Anesthesiologists (ASA). POLICY HISTORY/REVISION INFORMATION Date 0/0/206 Action/Description Revised list of Procedures that include Moderate Sedation Codes (attachment file detailing procedures that do not allow separate reimbursement for moderate sedation CPT codes ): o Added 039T, 039T, 02T, 02T, 026T, 027T, 028T, 029T, 030T, 03T, 032T, 033T, 03T, 03T, 036T, 320, 399, 66, 77767, 77768, 77770, 7777 and o Removed 0387T, 0388T, 3727, 933 and G08 Archived previous policy version ANESTHESIA T0

Anesthesia Services. UnitedHealthcare Medicare Reimbursement Policy Committee

Anesthesia Services. UnitedHealthcare Medicare Reimbursement Policy Committee Anesthesia Services Policy Number ANES08272009RP Approved By UnitedHealthcare Medicare Committee Current Approval Date 08/27/2014 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable

More information

OBSERVATION CARE EVALUATION AND MANAGEMENT CODES

OBSERVATION CARE EVALUATION AND MANAGEMENT CODES REIMBURSEMENT POLICY OBSERVATION CARE EVALUATION AND MANAGEMENT CODES Policy Number: ADMINISTRATIVE 232.8 T0 Effective Date: April, 205 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION...

More information

INPATIENT CONSULTATIONS

INPATIENT CONSULTATIONS INPATIENT CONSULTATIONS REIMBURSEMENT POLICY Policy Number: ADMINISTRATIVE 228.7 T0 Effective Date: February, 20 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION... OVERVIEW... REIMBURSEMENT

More information

CARE PLAN OVERSIGHT POLICY

CARE PLAN OVERSIGHT POLICY REIMBURSEMENT POLICY CARE PLAN OVERSIGHT POLICY Policy Number: ADMINISTRATIVE 7.0 T0 Effective Date: July, 20 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION... OVERVIEW... REIMBURSEMENT

More information

SAME DAY/SAME SERVICE

SAME DAY/SAME SERVICE SAME DAY/SAME SERVICE REIMBURSEMENT POLICY Policy Number: ADMINISTRATIVE 7. T0 Effective Date: June, 20 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION... OVERVIEW... REIMBURSEMENT

More information

Medical Coverage Policy Monitored Anesthesia Care (MAC)

Medical Coverage Policy Monitored Anesthesia Care (MAC) Medical Coverage Policy Monitored Anesthesia Care (MAC) Device/Equipment Drug Medical Surgery Test Other Effective Date: 9/1/2004 Policy Last Updated: 1/8/2013 Prospective review is recommended/required.

More information

Anesthesia Policy Annual Approval Date

Anesthesia Policy Annual Approval Date Policy Number 2016R0032B Anesthesia Policy Annual Approval Date 3/11/2015 Approved By REIMBURSEMENT POLICY CMS-1500 Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You

More information

Mississippi Board of Nursing

Mississippi Board of Nursing Mississippi Board of Nursing Regulating Nursing Practice www.msbn.state.ms.us 713 Pear Orchard Road, Suite 300 Ridgeland, MS 39157 Administration and Management of Intravenous (IV) Moderate Sedation POSITION

More information

The American Society of Anesthesiologists (ASA) has defined MAC as:

The American Society of Anesthesiologists (ASA) has defined MAC as: Medical Coverage Policy Monitored Anesthesia Care (MAC) sad EFFECTIVE DATE: 09 01 2004 POLICY LAST UPDATED: 11 04 2014 OVERVIEW The intent of this policy is to address anesthesia services for diagnostic

More information

TELEMEDICINE POLICY. Page

TELEMEDICINE POLICY. Page TELEMEDICINE POLICY REIMBURSEMENT POLICY Policy Number: ADMINISTRATIVE 4.8 T0 Effective Date: May, 203 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS.. APPLICATION... OVERVIEW... REIMBURSEMENT

More information

TELEMEDICINE POLICY. Page

TELEMEDICINE POLICY. Page TELEMEDICINE POLICY REIMBURSEMENT POLICY Policy Number: ADMINISTRATIVE 4.23 T0 Effective Date: July, 205 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS.. APPLICATION... OVERVIEW... REIMBURSEMENT

More information

Supply Policy. Approved By 1/27/2014

Supply Policy. Approved By 1/27/2014 Supply Policy Policy Number 2014R0006A Annual Approval Date 1/27/2014 Approved By National Reimbursement Forum United HealthCare Community & State Payment Policy Committee IMPORTANT NOTE ABOUT THIS You

More information

Anesthesia Policy. Approved By 3/11/2015

Anesthesia Policy. Approved By 3/11/2015 Anesthesia Policy Policy Number 2015R0032D Annual Approval Date 3/11/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for submission

More information

Observation Care Evaluation and Management Codes Policy

Observation Care Evaluation and Management Codes Policy Policy Number REIMBURSEMENT POLICY Observation Care Evaluation and Management Codes Policy 2016R0115A Annual Approval Date 3/11/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT

More information

*Reflex withdrawal from a painful stimulus is NOT considered a purposeful response.

*Reflex withdrawal from a painful stimulus is NOT considered a purposeful response. Analgesia and Moderate Sedation This Nebraska Board of Nursing advisory opinion is issued in accordance with Nebraska Revised Statute (NRS) 71-1,132.11(2). As such, this advisory opinion is for informational

More information

Add-On Codes Policy. Approved By 7/13/2016

Add-On Codes Policy. Approved By 7/13/2016 REIMBURSEMENT POLICY Policy Number 2016R0071F Annual Approval Date Add-On Codes Policy 7/13/2016 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible

More information

ANESTHESIA - Medicare

ANESTHESIA - Medicare ANESTHESIA - Medicare Policy Number: UM14P0008A2 Effective Date: August 19, 2014 Last Reviewed: January 1, 2016 PAYMENT POLICY HISTORY Version DATE ACTION / DESCRIPTION Version 2 January 1, 2016 Under

More information

PREVENTIVE MEDICINE AND SCREENING POLICY

PREVENTIVE MEDICINE AND SCREENING POLICY REIMBURSEMENT POLICY PREVENTIVE MEDICINE AND SCREENING POLICY Policy Number: ADMINISTRATIVE 238.13 T0 Effective Date: January 1, 2016 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION...

More information

DRAFT 7/17/07. Procedural Sedation and Rapid Sequence Intubation (RSI) Consensus Statement

DRAFT 7/17/07. Procedural Sedation and Rapid Sequence Intubation (RSI) Consensus Statement Procedural Sedation and Rapid Sequence Intubation (RSI) Consensus Statement Many patients with emergency medical conditions in emergency and critical care settings frequently experience treatable pain,

More information

Status Active. Reimbursement Policy Section: Anesthesia Services Policy Number: RP - Anesthesia - 001 Anesthesia Effective Date: June 1, 2015

Status Active. Reimbursement Policy Section: Anesthesia Services Policy Number: RP - Anesthesia - 001 Anesthesia Effective Date: June 1, 2015 Status Active Reimbursement Policy Section: Anesthesia Services Policy Number: RP - Anesthesia - 001 Anesthesia Effective Date: June 1, 2015 Anesthesia Policy Description: Definitions: This policy addresses

More information

PROCEDURAL SEDATION/ANALGESIA NCBON Position Statement for RN Practice

PROCEDURAL SEDATION/ANALGESIA NCBON Position Statement for RN Practice PROCEDURAL SEDATION/ANALGESIA NCBON Position Statement for RN Practice P.O. BOX 2129 Raleigh, NC 27602 (919) 782-3211 FAX (919) 781-9461 Nurse Aide II Registry (919) 782-7499 www.ncbon.com Issue: Administration

More information

Ambulance Policy. Approved By 7/8/2015

Ambulance Policy. Approved By 7/8/2015 Ambulance Number 2015R0123H Annual Approval Date 7/8/2015 Approved By Payment Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for submission of accurate claims. This

More information

OBSTETRICAL POLICY. Page

OBSTETRICAL POLICY. Page OBSTETRICAL POLICY REIMBURSEMENT POLICY Policy Number: ADMINISTRATIVE 200.14 T0 Effective Date: April 1, 2016 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION... OVERVIEW... REIMBURSEMENT

More information

ADVANCED MONITORING PARAMETERS 2015 QUICK GUIDE TO HOSPITAL CODING, COVERAGE AND PAYMENT

ADVANCED MONITORING PARAMETERS 2015 QUICK GUIDE TO HOSPITAL CODING, COVERAGE AND PAYMENT ADVANCED MONITORING PARAMETERS 2015 QUICK GUIDE TO HOSPITAL CODING, COVERAGE AND Overview: Coding and Payment Systems The procedures described are performed in the hospital setting, usually as an intraoperative

More information

Corporate Reimbursement Policy

Corporate Reimbursement Policy Corporate Reimbursement Policy Code Bundling Rules Not Addressed in ClaimCheck or Correct Coding Initiative File Name: code_bundling_rules_not_addressed_in_claim_check Origination: 6/2004 Last Review:

More information

Corporate Medical Policy

Corporate Medical Policy File Name: anesthesia_services Origination: 8/2007 Last CAP Review: 1/2016 Next CAP Review: 1/2017 Last Review: 1/2016 Corporate Medical Policy Description of Procedure or Service There are three main

More information

Telemedicine Policy Annual Approval Date

Telemedicine Policy Annual Approval Date Policy Number 2016R0046A Telemedicine Policy Annual Approval Date 4/08/2015 Approved By REIMBURSEMENT POLICY CMS-1500 Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You

More information

Center for Medicaid and State Operations/Survey and Certification Group

Center for Medicaid and State Operations/Survey and Certification Group DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-12-25 Baltimore, Maryland 21244-1850 Center for Medicaid and State Operations/Survey

More information

COMPOUNDS AND BULK POWDERS

COMPOUNDS AND BULK POWDERS COMPOUNDS AND BULK POWDERS CLINICAL POLICY Policy Number: PHARMACY 210.2 T2 Effective Date: May 1, 2013 Table of Contents CONDITIONS OF COVERAGE... COVERAGE RATIONALE BENEFIT CONSIDERATIONS... BACKGROUND...

More information

Assistant Surgeon Policy

Assistant Surgeon Policy Policy Number 2015R5000D Annual Approval Date Assistant Surgeon Policy 11/12/2014 Approved By REIMBURSEMENT POLICY Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You

More information

AMBULANCE SERVICES. Page

AMBULANCE SERVICES. Page AMBULANCE SERVICES COVERAGE DETERMINATION GUIDELINE Guideline Number: CDG.001.03 Effective Date: June 1, 2015 Table of Contents COVERAGE RATIONALE... DEFINITIONS. APPLICABLE CODES... REFERENCES... HISTORY/REVISION

More information

AMBULANCE SERVICES. Page

AMBULANCE SERVICES. Page AMBULANCE SERVICES COVERAGE DETERMINATION GUIDELINE Guideline Number: CS003.C Effective Date: July 1, 2015 Table of Contents COVERAGE RATIONALE... DEFINITIONS APPLICABLE CODES... REFERENCES... HISTORY/REVISION

More information

UNMH Procedural Sedation Privileges

UNMH Procedural Sedation Privileges o Initial privileges (initial appointment) o Renewal of privileges (reappointment) o Expansion of privileges (modification) All new applicants must meet the following requirements as approved by the UNMH

More information

UNM SRMC MODERATE AND DEEP SEDATION CLINICAL PRIVILEGES.

UNM SRMC MODERATE AND DEEP SEDATION CLINICAL PRIVILEGES. MODERATE DEEP SEDATION CLINICAL [ ] Initial Appointment [ ] Reappointment Instructions For some practitioners, the privilege of PROCEDURAL SEDATION is requested as a non-core privilege The individual requesting

More information

Radiology Multiple Imaging Reduction Policy

Radiology Multiple Imaging Reduction Policy Policy Number 2015R0085C Radiology Multiple Imaging Reduction Policy Annual Approval Date 7/8/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS You are responsible for submission

More information

Physical Medicine & Rehabilitation: Multiple Therapy Procedure Reduction Policy

Physical Medicine & Rehabilitation: Multiple Therapy Procedure Reduction Policy Policy Number 2015R0121C Physical Medicine & Rehabilitation: Procedure Reduction Policy Annual Approval Date 3/11/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT

More information

Preface. Summary of Changes. Table of Contents. Service Contacts. November 2014 Replaces: September 2014 S-5787 11/14

Preface. Summary of Changes. Table of Contents. Service Contacts. November 2014 Replaces: September 2014 S-5787 11/14 Preface Summary of Changes Table of Contents Service Contacts November 2014 Replaces: September 2014 S-5787 11/14 Preface The Wellmark Provider Guide and specialty guides are billing resources for providers

More information

Telemedicine Policy. Approved By 1/27/2014

Telemedicine Policy. Approved By 1/27/2014 REIMBURSEMENT POLICY Policy Number 2015R0046F Annual Approval Date Telemedicine Policy 1/27/2014 Approved By National Reimbursement Forum United HealthCare Community & State Payment Policy Committee IMPORTANT

More information

IMPORTANT NOTICE REGARDING NEW ANESTHESIA BILLING GUIDELINES AND REIMBURSEMENT PROCEDURES. February 2010

IMPORTANT NOTICE REGARDING NEW ANESTHESIA BILLING GUIDELINES AND REIMBURSEMENT PROCEDURES. February 2010 IMPORTANT NOTICE REGARDING NEW ANESTHESIA BILLING GUIDELINES AND REIMBURSEMENT PROCEDURES February 2010 This notice will serve as an update to the November 2008 Anesthesia Billing Guidelines and Reimbursement

More information

Modifier Reference Policy

Modifier Reference Policy Policy Number 2016R0111C Annual Approval Date Modifier Reference Policy 11/11/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for

More information

Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE

Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 44 BOARD OF DENTAL EXAMINERS Chapter 12 Anesthesia and Sedation Authority: Health Occupations Article, 4-205 Annotated Code of Maryland.01 Scope.

More information

Healthcare Inspection. Evaluation of Management of Moderate Sedation in Veterans Health Administration Facilities

Healthcare Inspection. Evaluation of Management of Moderate Sedation in Veterans Health Administration Facilities Department of Veterans Affairs Office of Inspector General Healthcare Inspection Evaluation of Management of Moderate Sedation in Veterans Health Administration Facilities Report No. 04-00330-15 November

More information

New Patient Visit. UnitedHealthcare Medicare Reimbursement Policy Committee

New Patient Visit. UnitedHealthcare Medicare Reimbursement Policy Committee New Patient Visit Policy Number NPV04242013RP Approved By UnitedHealthcare Medicare Committee Current Approval Date 12/16/2015 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable to

More information

Coding and Payment Guide for Anesthesia Services. An essential coding, billing and reimbursement resource for anesthesiology and pain management

Coding and Payment Guide for Anesthesia Services. An essential coding, billing and reimbursement resource for anesthesiology and pain management Coding and Payment Guide for Anesthesia Services An essential coding, billing and reimbursement resource for anesthesiology and pain management 2016 Contents Introduction...1 Coding Systems... 1 Claim

More information

AMBULANCE SERVICES. Table of Contents

AMBULANCE SERVICES. Table of Contents AMBULANCE SERVICES Protocol: MSC023 Effective Date: 4/1/2015 Table of Contents Page COMMERCIAL COVERAGE RATIONALE... 1 MEDICARE & MEDICAID COVERAGE RATIONALE... 4 DEFINITIONS... 4 APPLICABLE CODES... 5

More information

The ASA defines anesthesiology as the practice of medicine dealing with but not limited to:

The ASA defines anesthesiology as the practice of medicine dealing with but not limited to: 1570 Midway Pl. Menasha, WI 54952 920-720-1300 Procedure 1205- Anesthesia Lines of Business: All Purpose: This guideline describes Network Health s reimbursement of anesthesia services. Procedure: Anesthesia

More information

Global Days Policy. Approved By 7/13/2016

Global Days Policy. Approved By 7/13/2016 Global Days Policy Policy Number 2016R0005G Annual Approval Date 7/13/2016 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for submission

More information

SECTION 5 HOSPITAL SERVICES. Free-Standing Ambulatory Surgical Center

SECTION 5 HOSPITAL SERVICES. Free-Standing Ambulatory Surgical Center SECTION 5 HOSPITAL SERVICES Table of Contents 1 GENERAL POLICY... 2 1-1 Clients Enrolled in a Managed Care Plan... 3 1-2 Clients NOT Enrolled in a Managed Care Plan (Fee-for-Service Clients)..................

More information

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Sedation for diagnostic and therapeutic procedures in children and young people 1.1 Short title Sedation in children and young

More information

Advanced Monitoring Parameters 2015 Quick Guide to Hospital Coding, Coverage and Payment

Advanced Monitoring Parameters 2015 Quick Guide to Hospital Coding, Coverage and Payment Advanced Monitoring Parameters 2015 Quick Guide to Hospital Coding, Coverage and Payment The information in this quick guide is provided by our Healthcare Economics Department, which supports Respiratory

More information

Unlisted Services Policy

Unlisted Services Policy Policy Number 2016R7101B Annual Approval Date Unlisted Services Policy 11/11/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for submission

More information

REIMBURSEMENT POLICY CMS-1500 Physical Medicine & Rehabilitation: Multiple Therapy Procedure Reduction Policy 2/13/2013

REIMBURSEMENT POLICY CMS-1500 Physical Medicine & Rehabilitation: Multiple Therapy Procedure Reduction Policy 2/13/2013 Policy Number REIMBURSEMENT POLICY CMS-1500 Physical Medicine & Rehabilitation: Multiple Therapy Procedure Reduction Policy 2013R0121C Annual Approval Date 2/13/2013 Approved By National Reimbursement

More information

POLICIES AND PROCEDURES GOVERNING ANESTHESIA PRIVILEGING IN HOSPITALS

POLICIES AND PROCEDURES GOVERNING ANESTHESIA PRIVILEGING IN HOSPITALS POLICIES AND PROCEDURES GOVERNING ANESTHESIA PRIVILEGING IN HOSPITALS **Hospitals must review and revise with legal counsel and ensure compliance with State and federal laws and regulations. ASA intends

More information

EXTENDED HOURS HOME CARE SKILLED (PRIVATE DUTY) NURSING

EXTENDED HOURS HOME CARE SKILLED (PRIVATE DUTY) NURSING Status Active Medical and Behavioral Health Policy Section: Skilled Services Policy Number: IX-01 Effective Date: 04/23/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members

More information

Payment Policy. Evaluation and Management

Payment Policy. Evaluation and Management Purpose Payment Policy Evaluation and Management The purpose of this payment policy is to define how Health New England (HNE) reimburses for Evaluation and Management Services. Applicable Plans Definitions

More information

Professional/Technical Component Policy

Professional/Technical Component Policy Policy Number 2015R0012C Professional/Technical Component Policy Annual Approval Date 1/27/2014 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible

More information

professional billing module

professional billing module professional billing module Professional CMS-1500 Billing Module Coding Requirements...2 Evaluation and Management Services...2 Diagnosis...2 Procedures...2 Basic Rules...3 Before You Begin...3 Modifiers...3

More information

ANESTHESIA SERVICES (AS)

ANESTHESIA SERVICES (AS) ANESTHESIA SERVICES (AS) AS.1 ORGANIZATION SR.1 Anesthesia services shall be provided in an organized manner, and function under the direction of a qualified doctor of medicine or osteopathy (or other

More information

Patient Care Services Policy & Procedure Title: No. 8720-0059

Patient Care Services Policy & Procedure Title: No. 8720-0059 Page: 1 of 8 I. SCOPE: This policy applies to Saint Francis Hospital, its employees, medical staff, contractors, patients and visitors regardless of service location or category of patient. This policy

More information

Anesthesia Guidelines

Anesthesia Guidelines Anesthesia Guidelines Updated April 2012 Anesthesia BlueCross requires anesthesiologists and certified registered nurse anesthetists (CRNAs) to file claims using CPT anesthesia codes. We cover general

More information

TABLE 2 ASA Physical Status Classification

TABLE 2 ASA Physical Status Classification TABLE 2 ASA Physical Status Classification ASA Class I II III IV V Description A normal, healthy patient, without organic, physiologic, or psychiatric disturbances A patient with controlled medical conditions

More information

Preventive Medicine and Screening Policy

Preventive Medicine and Screening Policy REIMBURSEMENT POLICY Policy Number 2015R0013C Preventive Medicine and Screening Policy Annual Approval Date 3/11/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT

More information

Coding and Payment Guide for Anesthesia Services

Coding and Payment Guide for Anesthesia Services Coding and Payment Guide for Anesthesia Services An essential coding, billing, and payment resource for anesthesiology and pain management 2006 4th edition Contents Introduction...............................

More information

Credentialing Criteria for Privileges to Administer Sedation/Analgesia by the Non- Anesthesiologist

Credentialing Criteria for Privileges to Administer Sedation/Analgesia by the Non- Anesthesiologist Credentialing Criteria for Privileges to Administer Sedation/Analgesia by the Non- Anesthesiologist Administrative Policy & Procedure - Jersey Shore University Medical Center Document Number: JM-ADMIN-0004

More information

CH CONSCIOUS SEDATION

CH CONSCIOUS SEDATION Summary: CH CONSCIOUS SEDATION It is the policy of Carondelet Health that moderate conscious sedation of patients will be undertaken with appropriate evaluation and monitoring. Effective Date: 9/4/04 Revision

More information

Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students

Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students I. Introduction The administration of local anesthesia, sedation and general anesthesia is an integral part of the practice

More information

FAQs on Billing for Health and Behavior Services

FAQs on Billing for Health and Behavior Services FAQs on Billing for Health and Behavior Services by Government Relations Staff January 29, 2009 Practicing psychologists are eligible to bill for applicable services and receive reimbursement from Medicare

More information

Vaccines For Children Policy

Vaccines For Children Policy Policy Number 2016R7109K Vaccines For Children Policy Annual Approval Date 11/11/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for

More information

Coding and Payment Guide for Anesthesia Services. An essential coding, billing, and reimbursement resource for anesthesiology and pain management

Coding and Payment Guide for Anesthesia Services. An essential coding, billing, and reimbursement resource for anesthesiology and pain management Coding and Payment Guide for Anesthesia Services An essential coding, billing, and reimbursement resource for anesthesiology and pain management 2011 Contents Introduction...1 Coding Systems... 1 Claim

More information

Guidelines for the Use of Sedation and General Anesthesia by Dentists

Guidelines for the Use of Sedation and General Anesthesia by Dentists Guidelines for the Use of Sedation and General Anesthesia by Dentists I. Introduction The administration of local anesthesia, sedation and general anesthesia is an integral part of dental practice. The

More information

APPENDIX E: Tips for Completing the CMS (HCFA) 1500 Claim

APPENDIX E: Tips for Completing the CMS (HCFA) 1500 Claim APPENDIX E: Tips for Completing the CMS (HCFA) 1500 Claim Field Number Field Description Data Type Instructions Client / Member Information (Fields 1-13) 1 Coverage Check the appropriate box with an "X".

More information

Physical Medicine & Rehabilitation: Maximum Combined Frequency per Day Policy

Physical Medicine & Rehabilitation: Maximum Combined Frequency per Day Policy REIMBURSEMENT POLICY Policy Number Physical Medicine & Rehabilitation: Maximum Combined Frequency per Day Policy 2015R0101B Annual Approval Date 7/8/2015 Approved By Payment Policy Oversight Committee

More information

Anesthesia Services DESCRIPTION:

Anesthesia Services DESCRIPTION: Private Property of Florida Blue. This payment policy is Copyright 2012, Florida Blue. All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission

More information

NOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by

NOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by NOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by the American Medical Association. You are forbidden

More information

COMPLEMENTARY AND ALTERNATIVE MEDICINE

COMPLEMENTARY AND ALTERNATIVE MEDICINE COVERAGE DETERMINATION GUIDELINE COMPLEMENTARY AND ALTERNATIVE MEDICINE Guideline Number: CDG-A-025 Effective Date: August 1, 2013 Table of Contents COVERAGE RATIONALE... DEFINITIONS. APPLICABLE CODES...

More information

Title/Subject Procedural Sedation and Analgesia Page 1 of 10

Title/Subject Procedural Sedation and Analgesia Page 1 of 10 Policy Procedural Sedation and Analgesia Page 1 of 10 Scope: Providers and nurses (M.D., D.O., D.M.D., D.D.S., A.P.R.N., P.A., R.N.) with appropriate privileges and who have successfully demonstrated adequate

More information

Non-anesthesia Provider Procedural Sedation and Analgesia Considerations for Policy Development

Non-anesthesia Provider Procedural Sedation and Analgesia Considerations for Policy Development American Association of Nurse Anesthetists 222 South Prospect Avenue Park Ridge, IL 60068 www.aana.com Non-anesthesia Provider Procedural Sedation and Analgesia Considerations for Policy Development Purpose

More information

The emergency amendment of 8 AAC (m) is made permanent to read:

The emergency amendment of 8 AAC (m) is made permanent to read: The emergency repeal of 8 AAC 45.082(l)(2) is made permanent: (2) repealed 12/1/2015; The emergency amendment of 8 AAC 45.082(m) is made permanent to read: (m) A fee or other charge for medical treatment

More information

G U I D E L I N E S for Teaching Pain Control and Sedation to Dentists and Dental Students. As adopted by the October 2007 ADA House of Delegates

G U I D E L I N E S for Teaching Pain Control and Sedation to Dentists and Dental Students. As adopted by the October 2007 ADA House of Delegates for Teaching Pain Control and Sedation to Dentists and Dental Students As adopted by the October ADA House of Delegates I. INTRODUCTION The administration of local anesthesia, sedation and general anesthesia

More information

Reimbursement Policy General Coding Section Policy Number: RP - General Coding - 014 Observation Care Services Effective Date: June 1, 2015

Reimbursement Policy General Coding Section Policy Number: RP - General Coding - 014 Observation Care Services Effective Date: June 1, 2015 Status Active Reimbursement Policy Section: General Coding Section Policy Number: RP - General Coding - 014 Observation Care Services Effective Date: June 1, 2015 Observation Care Services Description:

More information

Regions Hospital Delineation of Privileges Orthopedic Surgery

Regions Hospital Delineation of Privileges Orthopedic Surgery Regions Hospital Delineation of Privileges Orthopedic Surgery Applicant s Last First M Date Instructions: Applicants must provide complete names and addresses f their references. Please DO NOT SEND letters

More information

What You Need to Know About Anesthesia Filing Guidelines

What You Need to Know About Anesthesia Filing Guidelines What You Need to Know About Anesthesia Filing Guidelines 2015 Edition Published by Provider Relations and Education Your Partners in Outstanding Quality, Satisfaction and Service This document provides

More information

RADIOPHARMACEUTICALS AND CONTRAST MEDIA

RADIOPHARMACEUTICALS AND CONTRAST MEDIA CLINICAL POLICY RADIOPHARMACEUTICALS AND CONTRAST MEDIA Policy Number: RADIOLOGY 034.10 T0 Effective Date: April 1, 2016 Table of Contents CONDITIONS OF COVERAGE... COVERAGE RATIONALE... DEFINITIONS...

More information

Modifier Reference Policy

Modifier Reference Policy Policy Number 2015R0111C Annual Approval Date Modifier Reference Policy 11/12/2014 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for

More information

Intraoperative Nerve Monitoring Coding Guide. March 1, 2010

Intraoperative Nerve Monitoring Coding Guide. March 1, 2010 Intraoperative Nerve Monitoring Coding Guide March 1, 2010 Please direct any questions to: Kim Brew Manager Reimbursement and Therapy Access Medtronic ENT (904) 279-7569 Rev 9/10 KB TO OUR PARTNERS IN

More information

CLAIM FORM REQUIREMENTS

CLAIM FORM REQUIREMENTS CLAIM FORM REQUIREMENTS When billing for services, please pay attention to the following points: Submit claims on a current CMS 1500 or UB04 form. Please include the following information: 1. Patient s

More information

Reimbursement for Physician- Administered Drugs:

Reimbursement for Physician- Administered Drugs: Reimbursement for Physician- Purchased and Physician- Administered Drugs: Understanding the Buy and Bill Process 60889-R5-V1 This information is provided d for your background education and is not intended

More information

There are four anesthesia categories as determined by CMS that affect payment of anesthesia services based on the provider rendering the services:

There are four anesthesia categories as determined by CMS that affect payment of anesthesia services based on the provider rendering the services: PROVIDER BILLING GUIDELINES Anesthesia Background Qualified medical professionals administer anesthesia to relieve pain while at the same time monitoring and controlling the patients health and vital bodily

More information

CPT Coding in Oral Medicine

CPT Coding in Oral Medicine CPT Coding in Oral Medicine CPT - Current Procedural Terminology Medical Code Set (00000-99999) Established as an indexing/coding system to standardize terminology among physicians and other providers

More information

Physician, Health Care Professional, Facility and Ancillary Provider Administrative Guide for American Medical Security Life Insurance Company

Physician, Health Care Professional, Facility and Ancillary Provider Administrative Guide for American Medical Security Life Insurance Company Physician, Health Care Professional, Facility and Ancillary Provider Administrative Guide for American Medical Security Life Insurance Company Insureds 2009 Contents How to contact us... 2 Our claims process...

More information

CARDIOLOGY PROCEDURES REQUIRING PRECERTIFICATION

CARDIOLOGY PROCEDURES REQUIRING PRECERTIFICATION CLINICAL POLICY CARDIOLOGY PROCEDURES REQUIRING PRECERTIFICATION Policy Number: CARDIOLOGY 026.6 T2 Effective Date: May 1, 2015 Table of Contents CONDITIONS OF COVERAGE... COVERAGE RATIONALE... BENEFIT

More information

Durable Medical Equipment, Orthotics and Prosthetics Multiple Frequency Policy

Durable Medical Equipment, Orthotics and Prosthetics Multiple Frequency Policy Policy Number REIMBURSEMENT POLICY Durable Medical Equipment, Orthotics and Prosthetics Multiple Frequency Policy 2015R0109C Annual Approval Date 7/8/2015 Approved By Payment Policy Oversight Committee

More information

The Impact of Regional Anesthesia on Perioperative Outcomes By Dr. David Nelson

The Impact of Regional Anesthesia on Perioperative Outcomes By Dr. David Nelson The Impact of Regional Anesthesia on Perioperative Outcomes By Dr. David Nelson As a private practice anesthesiologist, I am often asked: What are the potential benefits of regional anesthesia (RA)? My

More information

Sandra Parker, M.D. Chief Medical Officer, AltaPointe Health Systems Vice-Chair, University of South Alabama Department of Psychiatry

Sandra Parker, M.D. Chief Medical Officer, AltaPointe Health Systems Vice-Chair, University of South Alabama Department of Psychiatry Sandra Parker, M.D. Chief Medical Officer, AltaPointe Health Systems Vice-Chair, University of South Alabama Department of Psychiatry President-Elect, Alabama Psychiatric Physicians Association No Disclosures

More information

Remote Access Technologies/Telehealth Services Medicare Effective January 1, 2016

Remote Access Technologies/Telehealth Services Medicare Effective January 1, 2016 Remote Access Technologies/Telehealth Services Medicare Effective January 1, 2016 Prior Authorization Requirement Yes No Not Applicable * Not covered by Medicare but is covered by HealthPartners Freedom

More information

FREE STANDING BIRTH CENTERS - MHCP

FREE STANDING BIRTH CENTERS - MHCP FREE STANDING BIRTH CENTERS - MHCP Policy Number: SC14P0007A3 Effective Date: October 13, 2014 Last Reviewed: January 1, 2016 POLICY UPDATES POLICY VERSION DATE SUMMARY OF CHANGE(S) NUMBER Version 3 January

More information

Psychotherapy Professional Services

Psychotherapy Professional Services Status Active Reimbursement Policy Section: Behavioral Health Section Policy Number: RP - Behavioral Health - 001 Psychotherapy Professional Services Effective Date: June 1, 2015 Psychotherapy Professional

More information

PROCEDURAL SEDATION: PEDIATRIC AND NEONATAL Clinical Procedure Approved: February 2011 Next Review: February 2014

PROCEDURAL SEDATION: PEDIATRIC AND NEONATAL Clinical Procedure Approved: February 2011 Next Review: February 2014 NOTE: The electronic version of this document is the latest and only acceptable version. If you have a paper version, you are responsible for ensuring it is identical to the e-version. Printed material

More information

POSITION STATEMENT. Statement on the Use of Sedation and Analgesia in the Gastrointestinal Endoscopy Setting

POSITION STATEMENT. Statement on the Use of Sedation and Analgesia in the Gastrointestinal Endoscopy Setting POSITION STATEMENT Statement on the Use of Sedation and Analgesia in the Gastrointestinal Endoscopy Setting Disclaimer The Society of Gastroenterology Nurses and Associates, Inc. (SGNA) assumes no responsibility

More information

Photocure 2014 Reimbursement Guide. Billing for Blue Light Cystoscopy with Cysview (hexaminolevulinate hydrochloride) Medicare Program

Photocure 2014 Reimbursement Guide. Billing for Blue Light Cystoscopy with Cysview (hexaminolevulinate hydrochloride) Medicare Program Photocure 2014 Reimbursement Guide Billing for Blue Light Cystoscopy with Cysview (hexaminolevulinate hydrochloride) Medicare Program Cysview (hexaminolevulinate hydrochloride) is a photodynamic optical

More information