Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-6 - PHYSICIANS PROGRAM › Section 560-X-6-.13 - Covered Services: Details On Selected Services

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Acupuncture: Not covered.
(2) Administration of anesthesia is a covered
			 service when administered by or directed by a duly licensed physician for a
			 medical procedure which is a covered service under the Alabama Medicaid
			 Program. Medical direction by an anesthesiologist of more than four Certified
			 Registered Nurse Anesthetists (CRNAs) or Anesthesiology Assistants (AAs)
			 concurrently will not be covered. For billing purposes, anesthesia services
			 rendered with medical direction for one CRNA or AA is considered a service
			 performed by the anesthesiologist. In order to bill for medical supervision,
			 the anesthesiologist must be physically present and available within the
			 operating suite. "Physically present and available" means the anesthesiologist
			 would not be available to render direct anesthesia services to other patients.
			 However, addressing an emergency of short duration or rendering the requisite
			 CRNA or AA supervision activities (listed below in a. through g.) within the
			 immediate operating suite is acceptable as long as it does not substantially
			 diminish the scope of the supervising anesthesiologist's control. If a
			 situation occurs which necessitates the anesthesiologist's personal continuing
			 involvement in a particular case, medical supervision ceases to be available in
			 all other cases. In order for the anesthesiologist to be reimbursed for medical
			 supervision activities of the CRNA or AA, the anesthesiologist must document
			 the performance of the following activities:
(a) performs a pre-anesthesia examination and
			 evaluation;
(b) prescribes the
			 anesthesia plan;
(c) personally
			 participates in the most demanding procedures in the anesthesia plan, including
			 induction as needed, and emergencies;
(d) ensures that any procedures in the
			 anesthesia plan that he or she does not perform are performed by a qualified
			 individual;
(e) monitors the course
			 of anesthesia administration at frequent intervals;
(f) remains physically present and available
			 for immediate diagnosis and treatment of emergencies; and
(g) provides indicated post-anesthesia care.
Administration of anesthesia by a self-employed Certified
				Registered Nurse Anesthetist (CRNA) is a covered service when the CRNA has met
				the qualifications and standards set forth in Rule No.
				610-X-9-.01 through
				610-X-9-.04 of the Alabama Board
				of Nursing Administrative Code. The CRNA must enroll and receive a provider
				number to bill under the Alabama Medicaid Program. When billing for anesthesia
				services, providers shall follow the guidelines set forth in the current
				Relative Value Guide published by the American Society of Anesthesiologists for
				basic value and time units. No Physical Status Modifiers can be billed.
Administration of anesthesia by a qualified Anesthesiology
				Assistant (AA) is a covered service when the AA has met the qualifications and
				standards set forth in the Alabama Board of Medical Examiners Administrative
				Code. Reimbursement shall be made only when the AA performs the administration
				of anesthesia under the direct medical supervision of the
				anesthesiologist.
Anesthesia services may include, but are not limited to,
				general anesthesia, regional anesthesia, supplementation of local anesthesia,
				or other supportive treatment administered to maintain optimal anesthesia care
				deemed necessary by the anesthesiologist during the procedure. Anesthesia
				services include all customary preoperative and postoperative visits, the
				anesthesia care during the procedure, the administration of any fluids deemed
				necessary by the attending physician, and any usual monitoring procedures.
				Therefore, additional claims for such services should not be submitted.
(h) Local anesthesia is usually
			 administered by the attending surgeon and is considered to be part of the
			 surgical procedure being performed. Thus, additional claims for local
			 anesthesia by the surgeon should not be filed. Any local anesthesia
			 administered by an attending obstetrician during delivery (i.e. pudendal block
			 or paracervical block) is considered part of the obstetrical coverage. Thus,
			 additional claims for local anesthesia administered by an attending
			 obstetrician during delivery should not be filed.
(i) When regional anesthesia (i.e., nerve
			 block) is administered by the attending physician during a procedure, the
			 physician's fee for administration of the anesthesia will be billed at one-half
			 the established rate for a comparable service when performed by an
			 anesthesiologist. When regional anesthesia is administered by the attending
			 obstetrician during delivery (i.e., saddle block or continuous caudal), the
			 obstetrician's fee for administration of the anesthesia will be billed at
			 one-half the established rate for a comparable service performed by an
			 anesthesiologist. When regional anesthesia is administered by an
			 anesthesiologist during delivery or other procedure, the anesthesiologist's fee
			 will be covered and should be billed separately.
(j) When a medical procedure is a noncovered
			 service under the Alabama Medicaid Program, the anesthesia for that procedure
			 is also considered to be a noncovered service.