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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.2 Services, Benefits, Limitations, and Prior Authorization : 9.2.50 Pain Management

9.2.50
Pain management is a benefit of Texas Medicaid.
Procedure codes 62350, 62351, 62355, 62360, 62361, 62362, and 62365 billed on the same day as another surgical procedure performed by the same physician are paid according to multiple surgery guidelines.
Procedure codes 62350, 62351, 62355, 62360, 62361, 62362, and 62365 billed on the same day as an anesthesia procedure performed by the same physician are denied as included in the total anesthesia time.
Reimbursement to the physician for the surgical procedure is based on the assigned RVUs or maximum fee. Outpatient facilities are reimbursed at their reimbursement rate. Inpatient facilities are reimbursed under the assigned diagnosis-related group (DRG). No separate payment for the intrathecal pump is made.
Use the following procedure codes when billing for the implantation/revision/replacement of the pump/catheter:
 
Procedure codes 62367 and 62368 do not require prior authorization and are payable as a medical service only.
Refer to:
Subsection 9.2.39.38, “Implantable Infusion Pumps,” in this handbook for more information about implanted pumps.
Acute pain is defined as pain caused by occurrences such as trauma, a surgical procedure, or a medical disorder manifested by increased heart rate, increased blood pressure, increased respiratory rate, shallow respirations, agitation or restlessness, facial grimace, or splinting.
Chronic pain is defined as persistent, often lasting more than six months; symptoms are manifested similarly to that of acute pain.
Postoperative refers to the time frame immediately following a surgical procedure in which a catheter is maintained in the epidural or subarachnoid space for the duration of the infusion of pain medication.

Texas Medicaid & Healthcare Partnership
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