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2012 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 8. Physician : 8.2 Services, Benefits, Limitations, and Prior Authorization : 8.2.6 Anesthesia : 8.2.6.3 Anesthesia for Labor and Delivery

8.2.6.3
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 either 01960 or 01967 is the most appropriate procedure code.
The following procedure codes must be used for obstetrical anesthesia:
Procedure codes 01960 and 01967 are limited to once every 210 days when billed by any provider and are reimbursed a flat fee. The time reported must be in minutes and must 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 01968 or 01969 may be considered for reimbursement when submitted with procedure code 01967. For a Cesarean delivery following a planned vaginal delivery, the anesthesia administered during labor must be billed with procedure code 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 01968 or 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 procedure codes 01960 and 01967), Texas Medicaid 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.
Texas Medicaid reimburses the epidural anesthesia services and the delivery at full allowance when they are provided by the delivering obstetrician.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.