CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Office-based anesthesia and IV sedation by oral surgeons (CDT anesthesia codes)

Defines coverage and billing/reimbursement rules for general anesthesia, deep sedation, and IV moderate (conscious) sedation provided by an oral surgeon in the office setting when performed with a covered oral surgical CPT procedure; lists covered and not-covered CDT anesthesia codes and payment conditions.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyOffice-based anesthesia and IV sedation by oral surgeons (CDT anesthesia codes)

Policy CodePolicy N/A

Change Typeclarified

Effective DateMay 23, 2011

Next Review DateN/A

Key ActionOral surgeons must submit the oral surgical CPT procedure code and the anesthesia/sedation CDT code on a CMS1500 form for BCBSRI medical coverage to ensure correct claims processing.

SourceLink

POLICY UPDATE CHANGES

Policy states that general anesthesia and IV sedation by an oral surgeon in the office setting is a separate covered medical benefit when performed with a covered surgical CPT procedure.

3Covered CDT anesthesia codes

2CDT anesthesia codes not covered (member liability)

Policy summary

General anesthesia and intravenous (IV) sedation provided by an oral surgeon in the office setting are treated as separate medical benefit services when performed with a covered oral surgical CPT procedure. Benefits may vary by group/contract; refer to the member's Evidence of Coverage or Subscriber Agreement for the applicable "Surgery Services" benefit. Effective date: 05|23|2011; Policy last reviewed/updated: 01|15|2019.

Code lists (CDT anesthesia codes)

Covered CDT anesthesia codes (when filed with a covered medical CPT code)mixedCovered

D9222	deep sedation/general anesthesia, first 15 minutes
D9223	deep sedation/general anesthesia, each 15 minute increment
D9243	intravenous moderate (conscious) sedation/analgesia, each 15 minute increment

Not covered CDT anesthesia/sedation codes (member liability)mixedNot Covered

D9230	Inhalation of nitrous oxide/analgesia, anxiolysis
D9248	Non-intravenous conscious sedation

Billing, denial risk, and documentation

Billing Rule

Submit anesthesia and surgical codes together

Oral surgeons must submit the oral surgical CPT procedure code together with the anesthesia/sedation CDT code on a CMS1500 form for BCBSRI medical coverage to ensure correct claims processing.

D9222
D9223
D9243
D9230
D9248

Denial Risk

Anesthesia denied if no covered surgical CPT code

Anesthesia services will be denied when the procedure code submitted is not a covered medical procedure or when anesthesia is provided with a non-covered surgical procedure; such services are member liability.

Payment is made separately for anesthesia services in the office setting. Claims should include both the oral surgical CPT procedure code and the anesthesia/sedation CDT code on the CMS1500 form. Note: this change is a clarification (non-material) that anesthesia services are billed separately and must be submitted with the corresponding surgical code.

Policy changes

2011-05-23Effective

Policy effective date.

2019-01-15Last review

Policy last updated/last review date.

clarifiedLatest

Policy states that general anesthesia and IV sedation by an oral surgeon in the office setting is a separate covered medical benefit when performed with a covered surgical CPT procedure. Detail: Payment made separately for anesthesia services in the office setting; claims should include both oral surgical CPT and anesthesia CDT codes on CMS1500.