OAR 410-130-0368
Anesthesia Services

(1)

Anesthesia is not covered for procedures that are below the funding line on the Health Services Commission’s Prioritized List of Health Services (see OAR 410-141-0520).

(2)

Effective January 1, 2012 all anesthesia claims submitted must be billed in minutes only. This includes;

(a)

Claims for services provided prior to ¹⁄₁/12 that are submitted for the first time in 2012;

(b)

Resubmitted unpaid claims for services provided prior to ¹⁄₁/12; and

(c)

Adjustments made to claims for services performed prior to ¹⁄₁/12. Units must be converted by the provider from units to minutes.

(3)

Qualifier MJ (indicating minutes) must be added to all claims;

(a)

Claims with qualifier UN (indicating units) will be denied; and

(b)

Claims without a qualifier will be denied.

(4)

Reimbursement is based on the base units assigned to each anesthesia code listed in the current American Society of Anesthesiology Relative Value Guide plus one unit per each 15 minutes of anesthesia time, except for anesthesia for neuraxial labor analgesia/anesthesia/anesthesia (code 01967). See (5) below for reimbursement of neuraxial labor analgesia/anesthesia.

(a)

The Division of Medical Assistance Programs (Division) will automatically calculate payment by adding the base units of the billed anesthesia code plus a unit per each 15 minutes of anesthesia time;

(b)

Reimbursement will be made at a fraction of a unit for the last 1-14 minutes of anesthesia time;

(c)

Do not add base units in addition to minutes.

(5)

Anesthesia for neuraxial labor analgesia/anesthesia (code 01967) will be paid at a flat rate regardless of the units billed.

(6)

Reimbursement for qualifying circumstances codes 99100-99140 and modifiers P1-P6 is bundled in the payment for codes 00100-01999. Do not add charges for 99100-99140 and modifiers P1-P6 in charges for 00100-01999.

(7)

A valid consent form is required for all hysterectomies and sterilizations.

(8)

If prior authorization (PA) was not obtained for a procedure that requires PA, then the anesthesia services may not be paid. Refer to OAR 410-130-0200 (Prior Authorization) PA Table 130-0200-1.

(9)

Anesthesia services are not payable to the provider performing the surgical procedure except for moderate (conscious) sedation.

(10)

Moderate (conscious) sedation must be billed with codes 99143-99150.

[ED. NOTE: Tables referenced are available from the agency.]

Source: Rule 410-130-0368 — Anesthesia Services, https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-130-0368.

410–130–0000
Foreword 410–130–0005
Federally Qualified Primary Care Provider 410–130–0015
Doula Services 410–130–0160
Codes 410–130–0180
Drugs 410–130–0190
Tobacco Cessation 410–130–0200
Prior Authorization 410–130–0220
Not Covered/Bundled Services/Not Valid 410–130–0225
Teaching Physicians 410–130–0230
Administrative Medical Examinations and Reports 410–130–0240
Medical Services 410–130–0245
Early and Periodic Screening, Diagnostic and Treatment Program 410–130–0246
Lead Screening 410–130–0255
Immunizations, Vaccines for Children, and Immune Globulins 410–130–0365
Ambulatory Surgical Center and Birthing Center Services 410–130–0368
Anesthesia Services 410–130–0380
Surgery Guidelines 410–130–0562
Abortion 410–130–0580
Hysterectomies and Sterilization 410–130–0585
Family Planning Services 410–130–0587
Family Planning Clinic Services 410–130–0595
Maternity Case Management 410–130–0670
Death With Dignity 410–130–0680
Laboratory and Radiology 410–130–0700
HCPCS Supplies and DME

California:	Codes
Colorado:	C.R.S.
Nevada:	NRS
New York:	Laws
Oregon:	OAR, ORS
Texas:	Statutes
World:	Rome Statute, International Dictionary

OAR 410-130-0368 Anesthesia Services

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OAR 410-130-0368
Anesthesia Services