Noticias de Proveedores

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

Wednesday, Apriil 4, 2018

• 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.

FirstCare Awarded Recertification of its NCQA Accredited Status

Monday, March 19, 2018

Medicaid/CHIP—Upcoming Provider Revalidation Webinar

Monday, March 12, 2018