As part of that policy, Anthem said, “Anthem allows reimbursement for professional neuraxial epidural anesthesia services provided in conjunction with labor and delivery for up to 300 minutes … based on the time the provider is physically present with the member.” While anesthesiologists have been complying with the documentation requests, the phrase “based on the time the provider is physically present with the member” confused some because it could be interpreted as a departure for how OB anesthesia is normally billed.
For instance, once a neuraxial epidural is placed, anesthesiologists might not actually be “physically present with the member” throughout the entire labor and delivery, but they are still allowed to count the entire time until the epidural is removed as part of the anesthesia time. That’s why for procedure codes 01960 – Anesthesia for vaginal delivery only and 01967 – Neuraxial labor analgesia/anesthesia for planned vaginal delivery, Indiana Medicaid calculates time units as follows: one time unit for each 15-minute block of time billed in the first hour of service and, for subsequent hours of service, one unit of service for every 60-minute block of time or portion billed. In comparison, for non-OB anesthesia cases, time is calculated by converting each 15-minute block of time to one time unit.
Upon inquiry, an Anthem network relations consultant confirmed that Anthem follows the Indiana Medicaid guidelines for calculating OB anesthesia time units for all Anthem Medicaid plans, including time the provider is not physically present with the patient in the time units calculation. Namely, “for obstetrical anesthesia services, Anthem follows Indiana Medicaid guidelines and calculates one time unit for each 15-minute block of time billed in the first hour of service and, for subsequent hours of service, calculates one unit of service for every 60-minute block of time or portion billed.”
While the policy still means cases over 300 minutes will likely be flagged for additional documentation, it does not mean anesthesiologists will have to calculate OB anesthesia time units differently than Indiana Medicaid.
For more information about billing Anthem Medicaid in Indiana, check out the following resources:
- Anthem Blue Cross and Blue Shield Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect Professional Anesthesia Services Reimbursement Policy (page 3)
- Indiana Health Coverage Programs Provider Reference Module: Anesthesia Services (page 5)
- CIPROMS article, “Billing Anthem for Anesthesia Services during Labor and Delivery”
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