CRNA and E&M

[nalaxu]

We are getting denials from PA's Medicare for CRNAs when billing 99201 for cancelled procedures. Denial when performed/billed by this type of provider. One claim rep said the service is covered under a CRNA but another rep said this was an error. Is anyone getting payment from MC for these? I can't find any guidelines clarifying this.

 

[thomas7331]

Anesthesia is not my primary specialty area, but per my understanding, Medicare does not have a benefit for E&M services provided by CRNAs. Per the Medicare Claims Processing manual: "Medicare will pay for E/M services for specific non-physician practitioners (i.e., nurse practitioner (NP), clinical nurse specialist (CNS) and certified nurse midwife (CNM)) whose Medicare benefit permits them to bill these services. A physician assistant (PA) may also provide a physician service, however, the physician collaboration and general supervision rules as well as all billing rules apply to all the above non-physician practitioners." Since CRNA are not specifically named as a provider type for which E/M is designated as a benefit, I would not expect this to be paid.

 

[nalaxu]

Anesthesia is not my primary specialty area, but per my understanding, Medicare does not have a benefit for E&M services provided by CRNAs. Per the Medicare Claims Processing manual: "Medicare will pay for E/M services for specific non-physician practitioners (i.e., nurse practitioner (NP), clinical nurse specialist (CNS) and certified nurse midwife (CNM)) whose Medicare benefit permits them to bill these services. A physician assistant (PA) may also provide a physician service, however, the physician collaboration and general supervision rules as well as all billing rules apply to all the above non-physician practitioners." Since CRNA are not specifically named as a provider type for which E/M is designated as a benefit, I would not expect this to be paid.

Thank you Thomas. This is what I needed.