CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

General anesthesia and intravenous sedation by oral surgeons in office setting

Defines coverage of general anesthesia and IV sedation provided by an oral surgeon in the office setting when performed in conjunction with a covered oral surgical CPT procedure for Blue Cross Blue Shield Rhode Island members; lists covered and not-covered CDT anesthesia codes and notes member liability when performed with non-covered procedures.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyGeneral anesthesia and intravenous sedation by oral surgeons in office setting

Policy CodePolicy N/A

Change Typeclarified

Effective DateMay 23, 2011

Next Review DateN/A

Key ActionSubmit the oral surgical CPT procedure code and the anesthesia/sedation CDT code on the CMS-1500 form to ensure correct claims processing.

SourceLink

POLICY UPDATE CHANGES

Policy states general anesthesia/IV sedation by an oral surgeon in the office is covered when performed with a covered surgical CPT procedure.

3Covered CDT Anesthesia Codes

2Not Covered CDT Codes

Coverage Summary

Defines coverage of general anesthesia and IV sedation provided by an oral surgeon in the office setting when performed in conjunction with a covered oral surgical CPT procedure for Blue Cross Blue Shield Rhode Island members; lists covered and not-covered CDT anesthesia codes and notes member liability when performed with non-covered procedures.

Medically Necessary and Not Covered Criteria

Medically Necessary Coverage Criteria

Covered when ALL of the following are met:

ALL of the following

Anesthesia (general or intravenous sedation) is provided by an oral surgeon in the office setting
Anesthesia is performed in conjunction with a covered oral surgical CPT procedure code

Not Covered / Member Liability

Not covered when ANY of the following are true:

Anesthesia/sedation is provided in conjunction with a non-covered surgical procedure performed by an oral surgeon in the office setting

Member liable for charges

Procedure code submitted is not a covered medical procedure (anesthesia services denied)

Code Table

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

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

Not covered CDT anesthesia codes (member liability)mixedNot Covered

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

Provider Actions

Documentation Required

Submit both surgical CPT and anesthesia CDT codes

To ensure correct claims processing, the oral surgeon must submit the oral surgical CPT procedure code and the anesthesia/sedation CDT code on the CMS-1500 form filed for BCBSRI medical coverage.

Denial Risk

Denial when procedure is not a covered medical procedure

Anesthesia services will be denied when the procedure code submitted is not a covered medical procedure.

Billing Rule

Payment only when paired with covered CPT oral surgical code

Payment under the BCBSRI medical benefit for general anesthesia and IV sedation codes is allowed only when performed in conjunction with oral surgical CPT codes that are considered covered.

Background

General anesthesia and intravenous sedation provided by an Oral surgeon in the office setting is considered a separate covered medical benefit when performed in conjunction with a covered surgical CPT procedure code.

A separate payment is made for anesthesia services in the office setting; anesthesia services will be denied when the procedure code submitted is not a covered medical procedure.

Benefits may vary by group/contract; refer to the member Evidence of Coverage or Subscriber Agreement.