Reimbursement for Epidural Services for Anthem Plans in New Hampshire

Reimbursement for epidural sevices (CPT® code 01967 or a successor code) for Commercial and Federal Employee Program® (FEP®) Plans is determined using a base of five (5) units plus time actually spent by the anesthesiologist for face-to-face care of the patient (for example, time spent inserting the catheter, time spent with the patient for monitoring or additional services). 

 

Reimbursement for epidural servises is allowed for up to 20 time units (max 5 hours) per date of service. Anthem will conduct a post-pay review of epidural claims and if any claim has been reimbursed for more than 20 time units, we will adjust the claim to recover any monies overpaid.   

 

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