Billing Anesthesia Services
| Date: | June 19, 2024 |
| From: | Health Plan |
| To: | All Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan) Practitioners and Hospitals |
| Type: | Regulatory |
| Subject: | Billing Anesthesia Services |
| Business: | Medi-Cal Managed Care |
Billing Anesthesia Services
Anesthesia services (CPT codes 00100 through 01999) are reimbursed when medically necessary. To bill for anesthesia services, use the five-digit CPT code applicable to the procedure with the appropriate modifier.
Please see below for identified areas of billing issues that may cause denials or delay in reimbursement.
Billing Multiple Anesthesia Modifiers
When two or more modifiers are necessary to identify the anesthesia services, use Modifier 99 with the appropriate five-digit CPT anesthesia code and explain the applicable modifiers in the Additional Claim Information Field (box 19) of the claim or as an attachment for a paper submission or ASC X12N 837 v.5010 Note (NTE) Segments for an electronic submission. For an example, refer to: https://mcweb.apps.prd.cammis.medi-cal.ca.gov/assets/5CDDF961-08E7-42B8-87A1-E7BB26F5279F/anestcms.pdf?access_token=6UyVkRRfByXTZEWIh8j8QaYylPyP5ULO
CPT Code 01967 Billing Requirements
For CPT code 01967 (neuraxial labor analgesia/anesthesia for planned vaginal delivery), all claims of 20 units or more require that an anesthesia report be attached.
Time in Attendance with the Patient
Time in attendance is time when the anesthesiologist or Certified Registered Nurse Anesthetist (CRNA) monitors the patient receiving neuraxial labor analgesia, and the anesthesiologist or CRNA is readily and immediately available in the labor or delivery suite.
If billing for obstetrical regional anesthesia (CPT code 01967), in addition to the documentation requirements noted above, providers also must document “time in attendance” on the attached anesthesia report. Claims without such documentation will be denied. Only time in attendance with the patient may be billed.
If the time in attendance information does not fit into Additional Claim Information field (box 19) of the paper claim or ASC X12N 837 v.5010 Note (NTE) Segments for an electronic claim, a paper claim must be submitted and “see attached” noted in box 19 and attach the appropriate documentation.
For additional information on Anesthesia billing, please see https://mcweb.apps.prd.cammis.medi-cal.ca.gov/assets/A742D5B5-5CA4-4D4E-B4A4-8363A98628EF/anest.pdf?access_token=6UyVkRRfByXTZEWIh8j8QaYylPyP5ULO.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website WWW.HPSJ-MVHP.ORG
