§ 1150.52. Anesthesia services.
(a) Payment will be made for anesthesia services other than local anesthesia provided by an enrolled practitioner qualified to administer anesthesia only if either of the following conditions are met:
(1) The practitioner personally administered the anesthesia.
(2) The practitioner directed no more than four anesthesia procedures concurrently and did not perform other services while concurrently directing the procedures. If the physician is involved in more than four anesthesia procedures concurrently, they should be deemed supervision and the costs shall be included as part of the hospital’s costs.
(b) Payment for inpatient anesthesia includes:
(1) Preoperative visits.
(2) Inpatient postoperative visits provided during the number of postoperative or postpartum days specified in the Medical Assistance Program Fee Schedule for each surgical or obstetrical procedure, whether or not the postoperative or postpartum visits are related to the administration of anesthesia.
(c) When two or more surgical procedures are performed and anesthesia is provided by the same anesthesiologist during the same period of hospitalization, the anesthesiologist will be reimbursed at 100% for the highest allowable payment for one procedure and 25% for the second highest paying procedure, with no payment for additional procedures.
(d) The eligible places of service for physicians are as follows:
(1) Inpatient hospital.
(2) Short procedure unit.
(3) Hospital emergency rooms.
(e) The eligible places of service for dentists are as follows:
(1) Dentist’s office.
(2) Dental clinic.
(f) Payment for anesthesia services will not be made:
(1) To the practitioner performing the medical or surgical procedure or to an assistant surgeon, with the exception of a dentist who may bill for outpatient general anesthesia performed by a certified nurse anesthetist under the dentist’s supervision when provided for a compensable outpatient service and the applicable documentation is submitted to justify payment as described in the Dental handbook;
(2) If the Department denies payment for the medical or surgical procedure.
(3) For local anesthesia.
Source The provisions of this § 1150.52 adopted January 7, 1983, effective January 1, 1983, 13 Pa.B. 305; amended September 7, 1984, effective July 1, 1984, 14 Pa.B. 3252; amended September 30, 1988, effective October 1, 1988, 18 Pa.B. 4418. Immediately preceding text appears at serial pages (93506) to (93507).
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