Payment Policy Daily Management of Epidurals
Policy governing reimbursement for daily management of epidural administration (including epidural-PCA) and clarifying that daily management of IV-PCA is not separately reimbursed; applies to providers billing Blue Cross Blue Shield of Rhode Island products.
No material clinical or coverage changes in this revision.
Coverage and Billing Criteria
Daily management billing criteria
Covered when ALL of the following are met:
ALL of the following
- Daily management of the epidural is a covered service for all product lines.
- Daily hospital management of epidural administration is billed with CPT code 01996.
- CPT 01996 is submitted only once per day for a maximum of up to three days following surgery.
- Daily management of an IV-PCA is not separately reimbursed; the professional physician service is included in reimbursement for daily medical visits or an associated surgical procedure, and physicians should not bill IV-PCA as a separate procedure.
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