Current through Register Vol. 54, No. 44, November 2, 2024
(a)
Payment will be made for anesthesia services other than local anesthesia
provided by an enrolled practitioner qualified to administer anesthesia only if
either of the following conditions are met:
(1) The practitioner personally administered
the anesthesia.
(2) The
practitioner directed no more than four anesthesia procedures concurrently and
did not perform other services while concurrently directing the procedures. If
the physician is involved in more than four anesthesia procedures concurrently,
they should be deemed supervision and the costs shall be included as part of
the hospital's costs.
(b)
Payment for inpatient anesthesia includes:
(1)
Preoperative visits.
(2) Inpatient
postoperative visits provided during the number of postoperative or postpartum
days specified in the Medical Assistance Program Fee Schedule for each surgical
or obstetrical procedure, whether or not the postoperative or postpartum visits
are related to the administration of anesthesia.
(c) When two or more surgical procedures are
performed and anesthesia is provided by the same anesthesiologist during the
same period of hospitalization, the anesthesiologist will be reimbursed at 100%
for the highest allowable payment for one procedure and 25% for the second
highest paying procedure, with no payment for additional procedures.
(d) The eligible places of service for
physicians are as follows:
(1) Inpatient
hospital.
(2) Short procedure
unit.
(3) Hospital emergency
rooms.
(e) The eligible
places of service for dentists are as follows:
(1) Dentist's office.
(2) Dental clinic.
(f) Payment for anesthesia services will not
be made:
(1) To the practitioner performing
the medical or surgical procedure or to an assistant surgeon, with the
exception of a dentist who may bill for outpatient general anesthesia performed
by a certified nurse anesthetist under the dentist's supervision when provided
for a compensable outpatient service and the applicable documentation is
submitted to justify payment as described in the Dental handbook;
(2) If the Department denies payment for the
medical or surgical procedure.
(3)
For local anesthesia.
