Observation Stays No Longer Subject to Concurrent Review

STAR—Anesthesia Reimbursement Benefit Language Clarified for Texas Medicaid, Effective 05/01/2018

Wednesday, Apriil 4, 2018

Effective for dates of service on/after May 1, 2018, anesthesia reimbursement benefit language will be clarified for Texas Medicaid.
Anesthesia Reimbursement Benefit Language Clarifications
The following will be clarified in the Texas Medicaid Anesthesia Reimbursement benefit policy:
  • An anesthesia practitioner is defined as an anesthesiologist who performs the anesthesia service alone or medically directs a certified registered nurse anesthetist (CRNA), anesthesiologist assistants (AA) or other qualified professional.
  • When a single claim per client is billed by the anesthesiologist for medically directing anesthesia services of an anesthesia procedure provided by one CRNA, AA or qualified professional, the QY and U1 modifier combination must be billed together when the CRNA, AA or qualified professional is part of a clinic or group.
  • Modifiers QZ and U1 must be submitted when a CRNA has personally performed the anesthesia services, is not medically directed by the anesthesiologist and is directed by the physician. 
  • Epidural and subarachnoid infusion (not including labor and delivery): 
    • Epidural and subarachnoid infusion for pain management is payable for acute, chronic and postoperative pain management; 
    • Procedure code 01996 is payable to CRNAs and physicians and is limited to once per day and will be denied when billed on the same day as a surgical/anesthesia procedure; and 
    • Procedure code 01996 billed longer than 30 days requires medical necessity documentation. Cancer diagnoses are excluded from the 30-day limitation.

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