CSHCN Services Program 2010 > Physician > Benefits, Limitations, and Authorization Requirements

30.2.4.7 Reimbursement

To be reimbursed, providers of anesthesia services must include the following on submitted claims:

•Appropriate national anesthesia procedure codes

•Correct modifier(s)

•Name of the anesthesiologist or CRNA administering the anesthesia

•Exact amount of face-to-face time with the client

The anesthesiologist's reimbursement for medical direction of CRNAs and non-CRNA qualified professionals is 100 percent of the maximum allowable fee.

The CRNA's reimbursement for performing an anesthesia service when directed by a surgeon or anesthesiologist is 92 percent of the maximum allowable fee.

Refer to: Chapter 12, "Certified Registered Nurse Anesthetist (CRNA)" for more information on CRNA services.

If multiple CRNAs or anesthesiologists are providing anesthesia services for a client, only one CRNA and one anesthesiologist may be reimbursed.

Procedure codes 99100, 99116, 99135, and 99140 are qualifying circumstances that impact the character of the anesthesia services provided. These procedures are not payable alone, but are payable in addition to the anesthesia service. Documentation supporting the medical necessity for use of these procedure codes may be subject to retrospective review.