CSHCN 2009 > Certified Registered Nurse Anesthetist (CRNA) > Claims Information

12.3 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 modifier combinations:

•QX and U2-Services provided with medical direction of an anesthesiologist. (Must be submitted by a CRNA who provided services under the medical direction of an anesthesiologist.)

•QZ and U1-Services provided without medical direction of an anesthesiologist; with direction by the surgeon. (Must be submitted when a CRNA has personally performed the anesthesia services, is not medically directed by the anesthesiologist, and is directed by the surgeon.)

•Anesthesia time in minutes.

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

Modifiers U1 (indicating one anesthesia claim is expected) and U2 (indicating two anesthesia claims are expected) are state-defined modifiers that may be billed by an anesthesiologist or CRNA.

Modifier U1, indicating that only one claim will be submitted, cannot be billed by two providers for the same procedure, client, and date of service. Modifier U2, indicating that two claims will be submitted, can only be billed by two providers for the same procedure, client, and date of service if one of the providers was medically directed by the other. Denied claims may be appealed with supporting documentation of any unusual circumstances.

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 TMHP does not key any information from claim attachments. Superbills, or itemized statements, are not accepted as claim supplements.

Refer to: Chapter 36, "TMHP Electronic Data Interchange (EDI)" on page 36-1 for information on electronic claims submissions.

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

Section 5.7.1.3, "CMS-1500 Claim Form Instructions" for instructions on completing paper claims. Blocks that are not referenced are not required for processing by TMHP and may be left blank.