Wiki Anesthesia- 00731,00811, 00812, 00813- BCBS

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Cpg26b

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Our office has started receiving denials from BCBS from various different plans that are denying for medical necessity and non-covered. Looked into BCBS policy details and shows that medical necessity for anesthesia services has been revised to a very slim criteria that must be met in order for medical necessity to be met. Has anyone else been seeing these denials, and noticed a trend? Our office has tried requesting prior authorizations for these codes and are told a prior authorization may not be started as it is non-covered. What options do we have for our patients during their procedures EGD/Colonoscopy for Anesthesia? Has anyone found a different method for our CRNA's?
 
We are experiencing this issue with UHC Comm Plan in AZ. I cannot find a CPB that addresses this issue. We submit records and it still gets denied. I hate to see the Anthem policy which looks like it is really restricting anes for these endoscopy procedures! Other carriers are sure to follow.
 
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