UPDATE: The day after this article was published, IHCP announced that they have removed the CPR section of the Emergency Services Provider Reference Module.
Cardiopulmonary resuscitation (CPR) is now considered an “all-inclusive” procedure by the Indiana Health Coverage Programs (IHCP), and separately billed charges for complementary services will be denied according to an August 25, 2016, announcement.
A new “Cardiopulmonary Resuscitation” section was recently added to the IHCP Emergency Services Provider Reference Module outlining how CPT should be billed. In the past, certain emergency department services were considered outside of the scope of the CPR itself and were paid separately by IHCP, including an evaluation and management “visit” (usually level 5), endotracheal intubation, and placement of a central or arterial line. Based on the new guidelines, however, those services are now included in the CPT® code 92950 for CPR, and the new policy will be applied retroactively back to April 1, 2016.
This change in policy could mean a dramatic reduction in reimbursement for emergency physicians who perform these critical services. According to CIPROMS Vice President of Client Relations Andrea Halpern, the services now considered “all-inclusive” could account for as many as 14.43 RVUs or $482.89 from the Medicaid Fee Schedule.
Upon learning about the change, Halpern notified leaders of the Indiana chapter of the American College of Emergency Physicians, who promptly contacted the Indiana Family and Social Services Administration for clarification of the new guidelines. Most notably, Indiana ACEP leaders were concerned about the reasons for the change as well as the August 25 announcement of a policy that supposedly became effective on April 1.
For more information about the changes to CPR billing to Indiana Medicaid, review the IHCP Emergency Services Provider Reference Module, especially the Revision History on page iii.
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