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October 2, 2015

Important Update to Anesthesia Billing Procedures

October 2, 2015

Blue Cross and Blue Shield of Alabama has issued an important statement updating procedures for anesthesia billing.  Effective 12/28/2015, reimbursement for Anesthesia CPT Codes 00810 and 00740 will be based on a fixed fee instead of time. 00810 bills at $275 and 00740 bills at $248.

Here is the complete statement from BC/BS.

Currently, when moderate (conscious) sedation is an inherent part of furnishing a procedure, a single surgical procedure code should be billed. Effective December 28, 2015, modifier 47 should be used to indicate anesthesia by the surgeon when moderate (conscious) sedation is required in order to receive payment for both services.

When a provider renders only the surgical services but does not administer anesthesia – either because it is not needed or was administered by an anesthesiologist or certified registered nurse anesthetist (CRNA) – modifier 47 should not be used.

These billing guidelines apply to all providers.
Fees with and without modifier 47 can be found on the fee schedule for procedures affected by this policy.

Do you have questions about how this important change affects your practice? Contact the experts at Medical Business Management today to find out more.

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