anesthesia fee schedule - labor & industries (l&i ... · professional services fee schedule...
TRANSCRIPT
Professional Services Fee Schedule
Anesthesia Fees
Effective July 1, 2017
Anesthesia Services Fee Schedule
Effective for Dates of Service on or After
July 1, 2017
To Skip The Keys
&
Go To The Fees
Click Here
CPT® only are copyright 2016 American Medical Association Refer to Field Key for definitions Anesthesia Page 1
Professional Services Fee Schedule
Anesthesia Fees
Effective July 1, 2017
Copyright InformationPhysicians’ Current Procedural Terminology (CPT®) five-digit codes, descriptions, and other data only are copyright 2016 American Medical Association. All Rights Reserved. CPT® is a registered trademark of the American Medical Association.No fee schedules, basic units, relative values or related listings are included in CPT.AMA does not directly or indirectly practice medicine or dispense medical services.AMA assumes no liability for data contained or not contained herein.
This document is also on the department’s Internet web site at http://www.lni.wa.gov/ClaimsIns/Providers/Billing/FeeSched/.Updates to this manual can be found under ‘Updates and Corrections’ tab on the department’s Internet web site at http://feeschedules.lni.wa.gov/
Updates to this manual are also announced on the Medical Provider e-News listserv. Individuals may join the listserv at http://www.lni.wa.gov/Main/Listservs/Provider.asp.
CPT® only are copyright 2016 American Medical Association Refer to Field Key for definitions Anesthesia Page 2
Professional Services Fee Schedule
Anesthesia Fees
Effective July 1, 2017ANESTHESIA SERVICES FEE SCHEDULE
Fee schedule dollar value for services paid with the maximum Service paid on a “by report” basis.Procedure code is not covered.Service paid with base and time units.Service paid on a “by report” basis.
Column Description
ANES VALUE
Indicates the anesthesia base
units, maximum dollar value,
or coverage for the anesthesia
service.
Not CoveredMaximum FeeBy Report
BASE SOURCE
N/A Service not paid by base and time unit method
PAYMENT METHODIndicates the payment method
for the anesthesia service.
Indicates the source of the
anesthesia base units.
2017 CPT® anesthesia code.
CMSASA
Service paid based on a maximum dollar value.
Column Values
Base/Time
Dollar ValueBy Report
FSI
Fee Schedule Indicator
This column indicates the
payment status for the
procedure code.
Procedure code is not covered,Base unit source is the Centers for Medicare and Medicaid Base unit source is the American Society of Anesthesiologists’
Column Title
FIELD KEY:
CPT CODE
F
X
Paid using base units
No fee or RVUs available, paid By ReportFee set by RBRVS RVUsNon-covered code
NFlat Fee developed by the department
A
R
Not Covered
Value Definitions
2017 CPT® anesthesia code.
Anesthesia base units for services paid with the base and time Number
CPT® only are copyright 2016 American Medical Association Refer to Field Key for definitions Anesthesia Page 3
Professional Services Fee Schedule
Anesthesia Fees
Effective July 1, 2017
CPT® only are copyright 2016 American Medical Association Refer to Field Key for definitions Anesthesia Page 4
Professional Services Fee Schedule
Anesthesia Fees
Effective July 1, 2017
CPT®
CODE
ANES
VALUE
PAYMENT
METHOD BASE SOURCE FSI PRIOR AUTH
00100 5 Base/Time CMS A00102 6 Base/Time CMS A00103 5 Base/Time CMS A00104 4 Base/Time CMS A00120 5 Base/Time CMS A00124 4 Base/Time CMS A00126 4 Base/Time CMS A00140 5 Base/Time CMS A00142 4 Base/Time CMS A00144 6 Base/Time CMS A00145 6 Base/Time CMS A00147 4 Base/Time CMS A00148 4 Base/Time CMS A00160 5 Base/Time CMS A00162 7 Base/Time CMS A00164 4 Base/Time CMS A00170 5 Base/Time CMS A00172 6 Base/Time CMS A00174 6 Base/Time CMS A00176 7 Base/Time CMS A00190 5 Base/Time CMS A00192 7 Base/Time CMS A00210 11 Base/Time CMS A00211 10 Base/Time CMS A00212 5 Base/Time CMS A00214 9 Base/Time CMS A00215 9 Base/Time CMS A00216 15 Base/Time CMS A00218 13 Base/Time CMS A00220 10 Base/Time CMS A00222 6 Base/Time CMS A00300 5 Base/Time CMS A00320 6 Base/Time CMS A00322 3 Base/Time CMS A00326 Not Covered Not Covered ASA X00350 10 Base/Time CMS A00352 5 Base/Time CMS A00400 3 Base/Time CMS A00402 5 Base/Time CMS A00404 5 Base/Time CMS A00406 13 Base/Time CMS A00410 4 Base/Time CMS A
Anesthesia Fees
CPT® only are copyright 2016 American Medical Association Refer to Field Key for definitions Anesthesia Page 5
Professional Services Fee Schedule
Anesthesia Fees
Effective July 1, 2017CPT®
CODE
ANES
VALUE
PAYMENT
METHOD BASE SOURCE FSI PRIOR AUTH
00450 5 Base/Time CMS A00454 3 Base/Time CMS A00470 6 Base/Time CMS A00472 10 Base/Time CMS A00474 13 Base/Time CMS A00500 15 Base/Time CMS A00520 6 Base/Time CMS A00522 4 Base/Time CMS A00524 4 Base/Time CMS A00528 8 Base/Time CMS A00529 Not Covered Not Covered CMS X00530 4 Base/Time CMS A00532 4 Base/Time CMS A00534 7 Base/Time CMS A00537 10 Base/Time ASA A00539 18 Base/Time CMS A00540 12 Base/Time CMS A00541 15 Base/Time CMS A00542 15 Base/Time CMS A00546 15 Base/Time CMS A00548 17 Base/Time CMS A00550 10 Base/Time CMS A00560 15 Base/Time CMS A00561 Not Covered Not Covered CMS X00562 20 Base/Time CMS A00563 25 Base/Time CMS A00566 25 Base/Time CMS A00567 18 Base/Time CMS A00580 20 Base/Time CMS A00600 10 Base/Time CMS A00604 13 Base/Time CMS A00620 10 Base/Time CMS A00625 13 Base/Time CMS A00626 15 Base/Time CMS A00630 8 Base/Time CMS A00632 7 Base/Time CMS A00635 4 Base/Time CMS A00640 3 Base/Time CMS A00670 13 Base/Time CMS A00700 4 Base/Time CMS A00702 4 Base/Time CMS A00730 5 Base/Time CMS A00740 5 Base/Time CMS A
CPT® only are copyright 2016 American Medical Association Refer to Field Key for definitions Anesthesia Page 6
Professional Services Fee Schedule
Anesthesia Fees
Effective July 1, 2017CPT®
CODE
ANES
VALUE
PAYMENT
METHOD BASE SOURCE FSI PRIOR AUTH
00750 4 Base/Time CMS A00752 6 Base/Time CMS A00754 7 Base/Time CMS A00756 7 Base/Time CMS A00770 15 Base/Time CMS A00790 7 Base/Time CMS A00792 13 Base/Time CMS A00794 8 Base/Time CMS A00796 30 Base/Time CMS A00797 Not Covered Not Covered CMS X00800 4 Base/Time CMS A00802 5 Base/Time CMS A00810 5 Base/Time CMS A00820 5 Base/Time CMS A00830 4 Base/Time CMS A00832 6 Base/Time CMS A00834 Not Covered Not Covered CMS X00836 Not Covered Not Covered CMS X00840 6 Base/Time CMS A00842 4 Base/Time CMS A00844 7 Base/Time CMS A00846 8 Base/Time CMS A00848 8 Base/Time CMS A00851 Not Covered Not Covered CMS X00860 6 Base/Time CMS A00862 7 Base/Time CMS A00864 8 Base/Time CMS A00865 7 Base/Time CMS A00866 10 Base/Time CMS A00868 10 Base/Time CMS A00870 5 Base/Time CMS A00872 7 Base/Time CMS A00873 5 Base/Time CMS A00880 15 Base/Time CMS A00882 10 Base/Time CMS A00902 5 Base/Time CMS A00904 7 Base/Time CMS A00906 4 Base/Time CMS A00908 6 Base/Time CMS A00910 3 Base/Time CMS A00912 5 Base/Time CMS A00914 5 Base/Time CMS A00916 5 Base/Time CMS A
CPT® only are copyright 2016 American Medical Association Refer to Field Key for definitions Anesthesia Page 7
Professional Services Fee Schedule
Anesthesia Fees
Effective July 1, 2017CPT®
CODE
ANES
VALUE
PAYMENT
METHOD BASE SOURCE FSI PRIOR AUTH
00918 5 Base/Time CMS A00920 3 Base/Time CMS A00921 3 Base/Time CMS A00922 6 Base/Time CMS A00924 4 Base/Time CMS A00926 4 Base/Time CMS A00928 6 Base/Time CMS A00930 4 Base/Time CMS A00932 4 Base/Time CMS A00934 6 Base/Time CMS A00936 8 Base/Time CMS A00938 4 Base/Time CMS A00940 3 Base/Time CMS A00942 4 Base/Time CMS A00944 6 Base/Time CMS A00948 4 Base/Time CMS A00950 5 Base/Time CMS A00952 4 Base/Time CMS A01112 5 Base/Time CMS A01120 6 Base/Time CMS A01130 3 Base/Time CMS A01140 15 Base/Time CMS A01150 10 Base/Time CMS A01160 4 Base/Time CMS A01170 8 Base/Time CMS A01173 12 Base/Time CMS A01180 3 Base/Time CMS A01190 4 Base/Time CMS A01200 4 Base/Time CMS A01202 4 Base/Time CMS A01210 6 Base/Time CMS A01212 10 Base/Time CMS A01214 8 Base/Time CMS A01215 10 Base/Time CMS A01220 4 Base/Time CMS A01230 6 Base/Time CMS A01232 5 Base/Time CMS A01234 8 Base/Time CMS A01250 4 Base/Time CMS A01260 3 Base/Time CMS A01270 8 Base/Time CMS A01272 4 Base/Time CMS A01274 6 Base/Time CMS A
CPT® only are copyright 2016 American Medical Association Refer to Field Key for definitions Anesthesia Page 8
Professional Services Fee Schedule
Anesthesia Fees
Effective July 1, 2017CPT®
CODE
ANES
VALUE
PAYMENT
METHOD BASE SOURCE FSI PRIOR AUTH
01320 4 Base/Time CMS A01340 4 Base/Time CMS A01360 5 Base/Time CMS A01380 3 Base/Time CMS A01382 3 Base/Time CMS A01390 3 Base/Time CMS A01392 4 Base/Time CMS A01400 4 Base/Time CMS A01402 7 Base/Time CMS A01404 5 Base/Time CMS A01420 3 Base/Time CMS A01430 3 Base/Time CMS A01432 6 Base/Time CMS A01440 8 Base/Time CMS A01442 8 Base/Time CMS A01444 8 Base/Time CMS A01462 3 Base/Time CMS A01464 3 Base/Time CMS A01470 3 Base/Time CMS A01472 5 Base/Time CMS A01474 5 Base/Time CMS A01480 3 Base/Time CMS A01482 4 Base/Time CMS A01484 4 Base/Time CMS A01486 7 Base/Time CMS A01490 3 Base/Time CMS A01500 8 Base/Time CMS A01502 6 Base/Time CMS A01520 3 Base/Time CMS A01522 5 Base/Time CMS A01610 5 Base/Time CMS A01620 4 Base/Time CMS A01622 4 Base/Time CMS A01630 5 Base/Time CMS A01634 9 Base/Time CMS A01636 15 Base/Time CMS A01638 10 Base/Time CMS A01650 6 Base/Time CMS A01652 10 Base/Time CMS A01654 8 Base/Time CMS A01656 10 Base/Time CMS A01670 4 Base/Time CMS A01680 3 Base/Time CMS A
CPT® only are copyright 2016 American Medical Association Refer to Field Key for definitions Anesthesia Page 9
Professional Services Fee Schedule
Anesthesia Fees
Effective July 1, 2017CPT®
CODE
ANES
VALUE
PAYMENT
METHOD BASE SOURCE FSI PRIOR AUTH
01682 4 Base/Time CMS A01710 3 Base/Time CMS A01712 5 Base/Time CMS A01714 5 Base/Time CMS A01716 5 Base/Time CMS A01730 3 Base/Time CMS A01732 3 Base/Time CMS A01740 4 Base/Time CMS A01742 5 Base/Time CMS A01744 5 Base/Time CMS A01756 6 Base/Time CMS A01758 5 Base/Time CMS A01760 7 Base/Time CMS A01770 6 Base/Time CMS A01772 6 Base/Time CMS A01780 3 Base/Time CMS A01782 4 Base/Time CMS A01810 3 Base/Time CMS A01820 3 Base/Time CMS A01829 3 Base/Time CMS A01830 3 Base/Time CMS A01832 6 Base/Time CMS A01840 6 Base/Time CMS A01842 6 Base/Time CMS A01844 6 Base/Time CMS A01850 3 Base/Time CMS A01852 4 Base/Time CMS A01860 3 Base/Time CMS A01916 5 Base/Time CMS A01920 7 Base/Time CMS A01922 7 Base/Time CMS A01924 6 Base/Time ASA A01925 8 Base/Time ASA A01926 10 Base/Time ASA A01930 5 Base/Time CMS A01931 7 Base/Time CMS A01932 7 Base/Time ASA A01933 8 Base/Time ASA A01935 5 Base/Time CMS A01936 5 Base/Time CMS A01951 3 Base/Time CMS A01952 5 Base/Time CMS A01953 $51.60 Maximum Fee N/A F
CPT® only are copyright 2016 American Medical Association Refer to Field Key for definitions Anesthesia Page 10
Professional Services Fee Schedule
Anesthesia Fees
Effective July 1, 2017CPT®
CODE
ANES
VALUE
PAYMENT
METHOD BASE SOURCE FSI PRIOR AUTH
01958 5 Base/Time CMS A01960 5 Base/Time CMS A01961 7 Base/Time CMS A01962 8 Base/Time CMS A01963 10 Base/Time ASA A01965 4 Base/Time CMS A01966 4 Base/Time CMS A01967 5 Base/Time CMS A01968 3 Base/Time ASA A01969 5 Base/Time CMS A01990 7 Base/Time CMS A01991 3 Base/Time CMS A01992 5 Base/Time CMS A01996 $68.35 Maximum Fee N/A F01999 By Report By Report N/A N
CPT® only are copyright 2016 American Medical Association Refer to Field Key for definitions Anesthesia Page 11