In office Medicare patients

whughes9805

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We are a pain management clinic in Texas. We have received word from a third party that Medicare will not be covering anesthesia for in office procedures anymore. We cannot locate anything on their website. Has anyone heard anything about this or have a confirmation of it. If so, where did you locate it? Thank you
 
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We are a pain management clinic in Texas. We have received word from a third party that Medicare will not be covering anesthesia for in office procedures anymore. We cannot locate anything on their website. Has anyone heard anything about this or have a confirmation of it. If so, where did you locate it? Thank you
Hi there, did the third party provide a citation from Medicare or Novitas? It could be they've misinterpreted something.

I haven't seen or heard anything about a blanket ban, but MACs have been issuing tougher guidance on sedation with pain blocks. For example Novitas' LCD for epidurals that will go into effect Dec. 12:

Use of Moderate or Deep Sedation, General Anesthesia, or Monitored Anesthesia Care (MAC) is usually unnecessary or rarely indicated for these procedures and therefore, is not considered medically reasonable and necessary. Even in patients with a needle phobia and anxiety, typically oral anxiolytics suffice. In exceptional and unique cases, documentation must clearly establish the need for such sedation in the specific patient.

And their new facet joint intervention policy:

General anesthesia is considered not medically reasonable and necessary for facet joint interventions. Neither conscious sedation nor Monitored Anesthesia Care (MAC) is routinely necessary for intraarticular facet joint injections or medial branch blocks and are not routinely considered medically reasonable and necessary. Individual consideration may be given on redetermination (appeal) for payment in rare, unique circumstances if the medical necessity of sedation is unequivocal and clearly documented in the medical record. Frequent reporting of these services together may trigger focused medical review.
 
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