They might have a similar payment methodology as Medicare which packages the payment into the primary payment for the procedure.
100-04 Claims Processing Manual ? Chapter 04 ? Part B Hospital, ? Section 10.4 - Packaging - Hospital Outpatient Prospective Payment System lists anesthesia as a packaged item, and states:
?Under OPPS, packaged services are items and services that are considered to be an integral part of another service that is paid under the OPPS. No separate payment is made for packaged services, because the cost of these items is included in the APC payment for the service of which they are an integral part. For example, routine supplies, anesthesia, recovery room and most drugs are considered to be an integral part of a surgical procedure so payment for these items is packaged into the APC payment for the surgical procedure.?
For Medicare outpatient hospital facility services, under OPPS, the costs associated with anesthesia drugs and administration are included (bundled) in the payment for the surgery or procedure performed. Charging and billing for drugs may be separately reported with the appropriate HCPCS code, if available or with the appropriate revenue code. However, reimbursement is package into the procedure for which the anesthetic was used.
There are some procedures that include local anesthesia, and therefore are integral to the procedure and should not be separately reported. It is important to review the CPT coding guidelines and parenthetical notes before reporting local anesthesia to ensure proper billing. For example, anesthesia gases (e.g. isoflurane, desoflurane, etc.) should not be charged separately as they are in included in the anesthesia technical charge. However, the specific injectable drugs or other medications (fentanyl, versed, diprivan, antibiotics, etc.) that are use in relation to the procedure can be reported separately. We believe that revenue codes 636 or 25X are appropriate for reporting these drugs. Although some of these drugs can be reported separately, the majority of these drugs are also packaged and included in the surgery procedure charge.
While there is no immediate reimbursement for drugs used during anesthesia, CMS has asked that costs for packaged services and supplies be reported for data capture and future APC rate setting.
