Please Note: There is no Medicare information on our corporate website. Please select a specific contract in the 'Search Within' box for Medicare related information.
© 2019 Palmetto GBA, LLC
We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.
Printed Date: 9/22/2015
The following questions were received during the March 21, 2017, 'Documenting Anesthesia Services' Webcast.
Q. To be able to use the QZ pricing modifier, the state you are in must have opted out of the physician supervision requirement for CRNAs. Is that correct?
A. Opt out status is not a prerequisite for use of the QZ HCPCS modifier. Appropriate use of the QZ HCPCS modifier would depend upon specific state law for supervision requirements for a CRNA when anesthesia care is not performed under the medical direction of an anesthesiologist.
Q. If your state is not eligible for the use of the QZ HCPCS pricing modifier, if a CRNA is performing and emergency procedure after hours, does the Anesthesiologist have to be physically present on the campus or is it acceptable for him to be on call and available by phone/can be physically present within 30 minutes?
A. This would again refer to applicable state law, however, in an emergent situation patient care should be the highest priority.
Q. Is there a listing of the 'caine' drugs that should not be billed with anesthesia?
A. No there is no listing. However, when a drug is administered in the facility setting in the course of an anesthetic (MAC, general, regional) and the facility provides those resources it is not correct for the anesthesia provider to unbundle the drugs and/or supplies from the anesthesia services and to bill separately for them.
Q. Only one anesthesia code should be billed even though multiple procedures are performed?
A. Yes, when two or more anesthesia procedures are performed, providers should bill only the anesthesia code with the highest base rate value and report the total time, in minutes, for all anesthesia services performed.
Q. When moderate sedation is performed at the hospital and our radiologist only supervises the sedation, is it a billable charge by the radiologist or only by the facility?
A. It is not clear from the question exactly what the radiologist did. However, if the radiologist performed all the required elements of moderate sedation (the pre-, intra- and post-service work as described in CPT) then report applicable codes from CPT code 99151-99153 if the radiologist also performed the procedure the sedation supported.
Q. Do you have any guidance for billing code G0500?
A. HCPCS code G0050 is defined as ‘Moderate sedation services provided by the same physician or other qualified healthcare professional performing a gastrointestinal endoscopic service (excluding biliary procedures) that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intra‐service time.’
The Centers for Medicare & Medicaid Services (CMS) CY 2017 Physician Fee Schedule Final Rule includes a Moderate Sedation Work Values Table. The table identifies the GI endoscopy procedures for which HCPCS code G0500 should be used to report moderate sedation for Medicare patients when a surgeon performs both the moderate sedation service and the GI endoscopy procedures. You can access the table on the CMS website.
As this code is specific to moderate sedation by GI endoscopists, gastroenterology professional societies may be able to provide additional guidance.
Q. Is there any plans to update the new CPT for moderate sedation code 99153 so that it will have a professional component?
A. We are not aware of any plans. Any changes to the Medicare Physician Fee Schedule professional component/technical component indicator assigned to CPT code 99153 would be made by the Centers for Medicare & Medicare Services (CMS). Other changes to the CPT code would be made by the American Medical Association (AMA) as CPT codes are proprietary to the AMA.
Q. Do you cover Anesthesia services performed by physicians (not Anesthesiologists)?
A. Anesthesia services are paid based on the provider’s specialty and the procedure code billed. Anesthesia codes will only be paid to an anesthesiologist.
Addendum: Anesthesia services billed with CPT codes 00100-01999 may be covered when performed by physician anesthesiologists, CRNAs or Anesthesiologist Assistants (AAs).
Per 42 CFR Section 482.52, there are other listed persons who could perform anesthesia services, such as a doctor of medicine or osteopathy (other than an anesthesiologist), a CRNA (who, unless exempted in by state law, is under the supervision of the operating practitioner or of an anesthesiologist who is immediately available if needed) or an anesthesiologist's assistant, who is under the supervision of an anesthesiologist who is immediately available if needed. A provider who was not either of those would need to demonstrate their qualifications to receive payment for anesthesia services (CPT 00100-01999). Moderate sedation, billed with moderate sedation codes, can be reimbursed to other physicians or non-physician practitioners who are performing a procedure where moderate sedation would be appropriate in order to perform the procedure.
Q. Can we find the ADR online if we never received the ADR through mail?
A. If you are enrolled to receive these documents through our provider portal, eServices, they will be available there. If you are not registered to receive these documents via this route, Railroad Medicare mails ADRs using the provider address that is on file. You may wish to call our Contact Center at 888-355-9165 to make sure the address we have on file is current.
Q. I keep getting locked out of eServices and the admin for us is in another office and a different department. Is it possible for me to become an admin for my office?
A. The answer to this question can be found in eServices user guide (PDF, 7.79 MB).
Addendum: A provider administrator may grant administrative access to provider users on the eServices account. Please contact your provider administrator to request that access.
Q. On a side note, I have a quick question on how to enroll a group for a PTAN. Is there any way you can tell me or provide me with that information?
A. The Request for Railroad Medicare PTAN for Electronic Submitters Form is located on the is located on www.palmettogba.com/rr. Select 'Medicare Forms' from the Forms/Tools box on the main page. Then select 'I know the form I need'. The Request for Railroad Medicare PTAN for Electronic Submitters Form will be listed under the Provider Enrollment section. The form can be mailed or fax to the fax number and address listed on the form. If you have any additional questions please contact the Provider Contact Center at 1-888-355-9165.
Addendum: On April 17, 2017, Railroad Medicare launched a new PTAN Lookup and Request Tool that replaces the ‘Request for Railroad Medicare PTAN for Electronic Submitters’ form. We will no longer accept faxed, written, or telephone requests for enrollment. To enroll group members, please use the PTAN Lookup and Request Tool.
Q. Also, how can I get an individual's Railroad Medicare PTAN that joins a group that is already credentialed with Railroad Medicare?
A. The Request for Railroad Medicare PTAN for Electronic Submitters Form is located on www.palmettogba.com/rr. Select 'Medicare Forms' from the Forms/Tools box on the main page. The Request for Railroad Medicare PTAN for Electronic Submitters Form will be listed under the Provider Enrollment section. The form can be mailed or fax to the fax number and address listed on the form. If you have any additional questions please contact the Provider Contact Center at 1-888-355-9165.
Addendum: On April 17, 2017, Railroad Medicare launched a new PTAN Lookup and Request Tool that replaces the ‘Request for Railroad Medicare PTAN for Electronic Submitters’ form. We will no longer accept faxed, written, or telephone requests for enrollment. To enroll individual providers or group members, please use the PTAN Lookup and Request Tool.
Q. How will responses to records sent for ADR's be received? Via letter or ERA?
A. Thank you for your question, you will not receive a response by letter. The response will be received by standard paper remittance or electronic remittance advice. This will depend on how the provider receives them for their office. The claim will show as paid or denied based on the records received.
Addendum: If a claim has been denied for a clinical reason (not for lack of response), Medical Review will send a Denial Education letter to the provider, in addition to standard paper remittance or electronic remittance advice that will be sent for the claim.
We value your opinion and want to provide the highest-quality and most relevant Medicare knowledge possible. Please let us know if this article was helpful.
It didn't answer my question
This article was helpful
We’re glad we could help you today and appreciate your feedback. When you rate our articles as most helpful, we know that we are on the right track for providing you with important news and information.
We're sorry this article didn't help you today. We'll use your feedback to review this article to try to revise or expand it. Contact us with more feedback or a question on this topic.
Last Updated: 04/20/2017