CSHCN 2008 > Certified Registered Nurse Anesthetist (CRNA) > Claims Information

12.4 Claims Information

All CRNA services must be billed with a CRNA individual provider number, even if the CRNA is part of a group. Claims for anesthesia services provided by CRNAs must include the following:

•Appropriate CPT anesthesia procedure code for all procedures billed. If the anesthesia is given for more than one procedure identify all procedures performed and indicate what is considered the major procedure. A breakdown of charges is not necessary.

•One of the following modifiers:

•QX-Services with medical direction by a physician.

•QZ-Services without medical direction by a physician.

•Anesthesia time in minutes.

•Provider's usual and customary charges for services being billed.

CRNA services must be submitted to TMHP in an approved electronic format or on the CMS-1500 claim form. Providers may purchase CMS-1500 claim forms from the vendor of their choice. TMHP does not supply the forms.

When completing a CMS-1500 claim form, all required information must be included on the claim, as information is not keyed from attachments. Superbills, or itemized statements, are not accepted as claim supplements.

Refer to: Chapter 33, "TMHP Electronic Data Interchange (EDI)" on page 33-1, for information on electronic claims submissions.

Chapter 5, "Reimbursement and Claims Filing" on page 5-1, for general information about claims filing.

Chapter 5, "CMS-1500 Claim Form Instructions"on page 5-19, for instructions on completing paper claims. Blocks that are not referenced are not required for processing by TMHP and may be left blank.