405 IAC 5-10-3 Reimbursement parameters

Sec. 3. (a) Services rendered by an anesthetist shall be reimbursed as follows: (1) Directly to the CRNA, provided that the CRNA has a provider number based on current state registered nurse licensure and is certified or recertified by the Council on Certification of Nurse Anesthetists at the time services were rendered. (2) Directly to the AA, provided that the AA has a provider number based upon a current state license. (3) To an anesthesiologist or a professional corporation employing the anesthetist or anesthesiologist at the time services were rendered. (4) To a hospital or other health care facility employing the anesthetist or anesthesiologist at the time services were rendered. (b) When an anesthetic is administered for multiple surgical procedures performed during the same operative session, reimbursement will be predicated on the allowed Medicaid payment for the surgical procedure having the highest anesthesia relative value unit. (c) Anesthesia services must be billed using the coding system required by the office. Anesthesia services performed during separate operative sessions must be billed separately. Each service must be coded on a separate line in order to allow base value. This does not apply to extra services performed during the same anesthesia services. (d) Anesthesia services associated with canceled surgery will not be reimbursed. (e) Local anesthesia (therapeutic or regional blocks) will be reimbursed as a surgical procedure. Time units or modifying factors associated with local anesthesia are not reimbursable. Reimbursement for local anesthesia (therapeutic or regional blocks) administered by the surgeon in conjunction with a surgical procedure is included in the fee for the surgical procedure. (f) The following services will be reimbursed as surgical procedures: (1) Cardiopulmonary resuscitation. (2) Elective external cardioversion. (3) Administration of blood or blood components. (g) If reimbursement for a surgical procedure has been disallowed due to lack of prior authorization, reimbursement for the anesthesia service will also be disallowed. (h) Reimbursement is not available for equipment or supplies provided by either an anesthetist or anesthesiologist. Costs associated with equipment or supplies are the responsibility of the facility in which the anesthesia services are provided. (i) Reimbursement is available for medical direction of a procedure involving an anesthetist only when the direction is by an anesthesiologist, and only when the anesthesiologist medically directs two (2), three (3), or four (4) concurrent procedures involving qualified anesthetists. Reimbursement is not available for medical direction in cases in which an anesthesiologist is concurrently administering anesthesia and providing medical direction. (j) For single anesthesia sessions involving both an anesthesiologist and an anesthetist, the procedures performed during the session are considered personally performed by the anesthesiologist unless the office has received documentation that the involvement of both the anesthesiologist and the anesthetist in the procedure was medically necessary. In cases in which the office receives the medically necessary documentation, reimbursement may be made for the services of each practitioner.