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36.4.3.3 Anesthesia for Labor and Delivery
Providers must bill the most appropriate procedure code for the service provided. Other time-based procedure codes cannot be submitted if 7-01960 or 7-01967 is the most appropriate procedure code.
Epidural Anesthesia by the Delivering Obstetrician
The Texas Medicaid Program reimburses the anesthesia services and the delivery at full allowance when provided by the delivering obstetrician.
The following procedure codes must be used for obstetrical procedures:
Procedure codes 2-62311 and 2-62319 are reimbursed at an access-based maximum fee rate.
Procedure codes 7-01960 and 7-01967 are reimbursed at a flat fee and not by RVU. The time reported must be in minutes and should represent the total minutes between the start and stop times for these procedures, regardless of the time actually spent with the client. Providers are not required to report actual face-to-face minutes with the client for these procedure codes. Providers should refer to the definition of time in the CPT manual in the "Anesthesia Guidelines-Time Reporting" section.
Procedure code 7-01968 or 7-01969 may be considered for reimbursement when submitted with procedure code 7-01967. For a cesarean delivery following a planned vaginal delivery, the anesthesia administered during labor must be billed with procedure code 7-01967 and must indicate the time in minutes that represents the time between the start and stop times for the procedure. The additional anesthesia services administered during the operative session for a cesarean delivery must be submitted using procedure code 7-01968 or 7-01969 and must indicate the time spent administering the epidural and the actual face-to-face time spent with the client. The insertion and injection of the epidural are not considered separately for reimbursement.
All time must be documented in block 24D of the claim form or the appropriate field of the chosen electronic format.
For continuous epidural analgesia procedure codes (other than 7-01960 and 7-01967), the Texas Medicaid Program reimburses providers for the time when the physician is physically present and monitors the continuous epidural. Reimbursable time refers to the period between the catheter insertion and when the delivery commences.
Procedure code 1-99140 is not considered for reimbursement when submitted with diagnosis code 650, 66970, or 66971 if one of these diagnoses is documented on the claim as the referenced diagnosis. The referenced diagnosis must indicate the complicating condition.
Epidural Anesthesia by a Provider other than the Delivering Obstetrician
The following procedure codes must be used for epidural anesthesia when provided by a provider other than the delivering obstetrician:
Procedure codes 7-01960 and 7-01967 are reimbursed at a flat fee and not by RVU. The time reported must be in minutes and should represent the total minutes between the start and stop times for these procedures, regardless of the time actually spent with the client. Providers are not required to report actual face-to-face minutes with the client for these procedure codes. Providers should refer to the definition of time in the CPT manual in the "Anesthesia Guidelines-Time Reporting" section.
Procedure code 7-01968 or 7-01969 may be considered for reimbursement when submitted with procedure code 7-01967. For a cesarean delivery following a planned vaginal delivery, the anesthesia administered during labor must be billed with procedure code 7-01967 and must indicate the time in minutes that represents the time between the start and stop times for the procedure. The additional anesthesia services administered during the operative session for a cesarean delivery must be submitted using procedure code 7-01968 or 7-01969 and must indicate the time spent administering the epidural and the actual face-to-face time spent with the client. The insertion and injection of the epidural are not considered separately for reimbursement.
All time must be documented in block 24D of the claim form or the appropriate field of the chosen electronic format.
Procedure codes 2-62311 and 2-62319 must be used when the anesthesiologist or CRNA provides the epidural anesthesia during labor only. Procedure codes 2-62311 and 2-62319 are considered for reimbursement at an access-based maximum fee rate.
Procedure code 1-99140 is not considered for reimbursement when submitted with diagnosis code 650, 66970, or 66971 if one of these diagnoses is documented on the claim as the referenced diagnosis. The referenced diagnosis must indicate the complicating condition.
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