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Wiki BCBS not covering mac anethesia

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klmklahn78@yahoo.com

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Please help is anyone else having claims not being covered because of mac anesthesia being used for a colonoscopy??? How do you bill with the use of TIVA, even if op reports states mac was used?? This is just a recent problem we have discovered and BCBS shield states they will not cover claim if mac was used. Any help will be appreciated. Thank you.
 
We are having the same issue with BCBS out of state plans, some plans are stating that unless MAC is medically necessary they will not cover/reimburse you. We did try to submit medical documentation, some of our claims did get reprocessed and paid, but some are coming back with a no, and we are billing the patients, our contracted fee with BCBS.
 
The endoscopy CPT codes have moderate sedation bundled into them.
In order to get paid for MAC, you must demonstrate medical necessity.
I've included the link for the Novitas LCD regarding MAC anesthesia.......you might consider researching you Blue MAC policy. Some Blue's won't pay for CRNA services.
https://www.novitas-solutions.com/policy/jh/l32628-r4.html

General anesthesia, regional anesthesia and MAC anesthesia are the acceptable modes of reporting anesthesia services.

FYI: Anthem BC/BS of Indiana is paying a flat fee for anesthesia for endoscopy, etc......
http://www.ciproms.com/NewsEvents/t...olicy-Revisions-of-Anesthesia-Procedures.aspx
 
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