Reimbursement policy update: Professional anesthesia services

Policy update

Professional anesthesia services

(Policy 06-019, effective 09/01/2019)

 

HealthKeepers, Inc. allows reimbursement of anesthesia services rendered by professional providers for covered Anthem HealthKeepers Plus members. Reimbursement is based upon:

 

• The reimbursement formula for the allowance and time increments in accordance with Department of Medical Assistance Services’ guidelines.

 

• Proper use of applicable modifiers.

 

Providers must report anesthesia services in minutes. Anesthesia claims submitted with an indicator other than minutes may be rejected or denied. Start and stop times must be documented in the member’s medical record. Anesthesia time starts with the preparation of the member for administration of anesthesia and stops when the anesthesia provider is no longer in personal and continuous attendance. The reimbursement formula for anesthesia allowance is based on state guidelines.

 

Effective September 1, 2019, HealthKeepers, Inc. reimburses neuraxial epidural anesthesia services provided in conjunction with labor and delivery at a flat rate regardless of time involved.

 

Please refer to the Professional Anesthesia Services reimbursement policy for additional details at https://mediproviders.anthem.com/va.