Incorrect Anesthesia Rates Displayed on Static Fee Schedule PRCR400C for CRNA Services Procedure Codes Information posted Dec. 1, 2017

Note: Texas Medicaid managed care organizations) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

TMHP has identified an issue that impacts the PRCR400C, “Certified Registered Nurse Anesthetist (CRNA)/ Anesthesiologist Assistant (AA),” static fee schedule available for download on this website.

The fee schedule posted Nov. 2, 2017, does not reflect the correct reimbursement rates for CRNA services for some type of service 1 and TOS 2 anesthesia procedure codes. The rates displayed on the Nov. 2, 2017 fee schedule reflect 100 percent of the physician fee(s) instead of the appropriate 92 percent of the physician fee(s) for some CRNA services procedure codes.

Although the Nov. 2, 2017, fee schedule does not reflect the appropriate fees for certain CRNA services, claims are processing appropriately. No action is required by providers.

The November static fee schedule will be corrected with the next fee schedule update, which is scheduled for release on Dec. 8, 2017.