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29.2.4.6 Services Not Considered Incidental to Surgery or Anesthesia
The following table lists surgical procedure codes that are not considered incidental to surgery or anesthesia procedures and may be reimbursed separately in the inpatient and outpatient setting:
Authorization is not required for these services when they are incidental to surgery, assistant surgery, or anesthesia. Multiple surgical procedures billed on the same day by the same provider are subject to the multiple surgery guidelines. The surgical procedure codes that are not considered incidental to surgery or anesthesia require authorization when performed as outpatient hospital day surgery in an ambulatory surgical center (ASC) or hospital ambulatory surgical center (HASC).
When procedure codes 31500, 93312, 93313, 93314, 93315, 93316, and 93317, or 99291 and 99292 are performed due to a separate incident not related to the original surgery after the postoperative recovery period, they may be reimbursed on appeal with appropriate documentation of medical necessity.
Procedure codes 93312, 93313, 93314, 93315, 93316, and 93317 may be considered for the exception noted above with documentation of a formal report.
If the need arises for a monitoring line such as a central venous catheter in the postoperative period (e.g., in the recovery room), this may be reimbursed as an additional service on appeal with appropriate documentation. Payment for monitoring lines when billed as the sole procedure performed may be reimbursed.
Providers must code the procedures in Block 24D of the CMS-1500 claim form with a valid Current Procedural Terminology (CPT) anesthesia code.
If procedure code 01996 is used, it must be reported as a medical service rather than an anesthesia service.
Procedure codes 99100, 99116, 99135, and 99140 are qualifying circumstances that impact the character of the anesthesia services provided. These codes may only be reimbursed when billed with an anesthesia procedure or service.
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