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36.4.3.12 Services Incidental to Surgery and/or Anesthesia
Surgical and anesthesia services are benefits of the Texas Medicaid Program when they are medically necessary.
Certain services that are performed in conjunction with surgical or anesthesia procedures are considered incidental to the surgery or anesthesia and are denied as included in the surgical/anesthesia fee. The following table includes, but may not be limited to, services that are incidental to surgery or anesthesia:
Procedure codes 2-33967, 2-33970, 2-36013, and 2-36014 (not an all-inclusive list) are services that are incidental to the anesthesia fee.
The following table includes procedure codes that are not incidental to surgery or anesthesia procedures and may be considered for reimbursement separately in addition to the surgery or anesthesia service in the inpatient or outpatient setting:
Should the need arise for the insertion of a monitoring line due to a separate incident not related to the original surgery after the post-operative recovery period, reimbursement may be considered on appeal with appropriate documentation. Reimbursement for monitoring lines submitted as the sole procedure performed is allowed.
Procedure codes 4/I/T-93312, 4/I/T-93313, 4/I/T-93314, 4/I/T-93315, 4/I/T-93316, and 4/I/T-93317 (Transesophageal echocardiography) may be considered for reimbursement on appeal with appropriate documentation when performed for diagnostic purposes with documentation of a formal report and when due to a separate incident not related to the original surgery after the post-operative recovery period.
Critical care procedure codes 1-99291 and 1-99292 performed due to a separate incident not related to the original surgery after the postoperative recovery period may be considered for reimbursement on appeal with appropriate documentation.
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