Current through Register Vol. 24-18, September 15, 2024
The medicaid agency bases coverage of anesthesia services on
medicare policies and the following rules:
(1) The agency reimburses providers for
covered anesthesia services performed by:
(a)
Anesthesiologists;
(b) A doctor of
medicine or osteopathy (other than an anesthesiologist);
(c) Certified registered nurse anesthetists
(CRNAs);
(d) Oral surgeons with a
special agreement with the agency to provide anesthesia services; and
(e) Other providers who have a special
agreement with the agency to provide anesthesia services.
(2) The agency covers and reimburses
anesthesia services for children and noncooperative clients in those situations
where the medically necessary procedure cannot be performed if the client is
not anesthetized. A statement of the client-specific reasons why the procedure
could not be performed without specific anesthesia services must be kept in the
client's medical record. Examples of such procedures include:
(a) Computerized tomography (CT);
(b) Dental procedures;
(c) Electroconvulsive therapy; and
(d) Magnetic resonance imaging
(MRI).
(3) The agency
covers anesthesia services provided for any of the following:
(a) Dental restorations and/or
extractions:
(b) Maternity per
subsection (9) of this section. See WAC
182-531-1550
for information about sterilization/hysterectomy anesthesia;
(c) Pain management per subsection (5) of
this section;
(d) Radiological
services as listed in WAC
182-531-1450;
and
(e) Surgical
procedures.
(4) For each
client, the anesthesiologist provider must do all of the following:
(a) Perform a preanesthetic examination and
evaluation;
(b) Prescribe the
anesthesia plan;
(c) Personally
participate in the most demanding aspects of the anesthesia plan, including, if
applicable, induction and emergence;
(d) Ensure that any procedures in the
anesthesia plan that the provider does not perform, are performed by a
qualified individual as defined in the program operating
instructions;
(e) At frequent
intervals, monitor the course of anesthesia during administration;
(f) Remain physically present and available
for immediate diagnosis and treatment of emergencies; and
(g) Provide indicated post anesthesia
care.
(5) The agency does
not allow the anesthesiologist provider to:
(a) Direct more than four anesthesia services
concurrently; and
(b) Perform any
other services while directing the single or concurrent services, other than
attending to medical emergencies and other limited services as allowed by
medicare instructions.
(6) The agency requires the anesthesiologist
provider to document in the client's medical record that the medical direction
requirements were met.
(7) General
anesthesia:
(a) When a provider performs
multiple operative procedures for the same client at the same time, the agency
reimburses the base anesthesia units (BAU) for the major procedure
only.
(b) The agency does not
reimburse the attending surgeon for anesthesia services.
(c) When more than one anesthesia provider is
present on a case, the agency reimburses as follows:
(i) The supervisory anesthesiologist and
certified registered nurse anesthetist (CRNA) each receive 50 percent of the
allowed amount.
(ii) For anesthesia
provided by a team, the agency limits reimbursement to 100 percent of the total
allowed reimbursement for the service.
(8) Pain management:
(a) The agency pays CRNAs or
anesthesiologists for pain management services.
(b) The agency allows two postoperative or
pain management epi-durals per client, per hospital stay plus the two
associated E&M fees for pain management.
(9) Maternity anesthesia:
(a) To determine total time for obstetric
epidural anesthesia during normal labor and delivery and c-sections, time
begins with insertion and ends with removal for a maximum of six hours.
"Delivery" includes labor for single or multiple births, and/or cesarean
section delivery.
(b) The agency
does not apply the six-hour limit for anesthesia to procedures performed as a
result of post-delivery complications.
(c) See WAC
182-531-1550
for information on anesthesia services during a delivery with
sterilization.
(d) See chapter
182-533 WAC for more information about maternity-related
services.
11-14-075, recodified as §182-531-0300, filed 6/30/11,
effective 7/1/11. Statutory Authority:
RCW
74.08.090. 10-19-057, § 388-531-0300,
filed 9/14/10, effective 10/15/10. Statutory Authority:
RCW
74.08.090,
74.09.520. 01-01-012, §
388-531-0300, filed 12/6/00, effective
1/6/01.
