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15.3 Benefits and Limitations
Medically necessary services performed by a CRNA are benefits if the services are within the scope of the CRNA's practice as defined by state law; are prescribed, supervised by, and provided under the direction of a supervising physician (MD or DO), dentist, or podiatrist licensed in the state in which they practice; or are provided under one of the following conditions:
• No physician anesthesiologist is on the medical staff of the facility where the services are provided (e.g., rural settings).
•No physician anesthesiologist is available to provide the services, as determined by the policies of the facility in which the services are provided.
•The physician performing the procedure requiring the services specifically requests the services of a CRNA.
•The eligible client requiring the services specifically requests the services of a CRNA.
•The CRNA is scheduled or assigned to provide the services according to policies of the facility in which the services are provided.
•The services are provided by the CRNA in connection with a medical emergency.
The Texas Medicaid Program does not reimburse the CRNA for equipment, drugs, or supplies-they are the responsibility of the facility where the CRNA services are provided. If the equipment, drugs, and supplies are covered and reimbursable by the Texas Medicaid Program, payment is considered for the Medicaid-enrolled facility. The basis and amount of reimbursement depends on the reimbursement methodology used by the Texas Medicaid Program for the services and providers involved.
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