Currentharvard pilgrim health carePolicy N/A

Anesthesia Surgical Procedure Code List

List of CPT procedure codes for which anesthesiologists are eligible for compensation at the network contracted rate; accepted by Tufts Health Plan. Note that presence or absence of a code does not guarantee coverage or payment. Some interventional pain management codes may be subject to prior authorization through NIA per separate matrix.

Policy Summary

Payerharvard pilgrim health care

PolicyAnesthesia Surgical Procedure Code List

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionAnesthesiologists are eligible for compensation for listed CPT procedure codes at the network contracted rate; presence or absence of a code is not a guarantee of coverage or payment.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes noted in this brief.

~170Listed CPT codes

0Material change

Policy summary

This is the Tufts Health Plan list of CPT procedure codes accepted for anesthesiologist compensation (used by the Harvard Pilgrim distribution). Anesthesiologists are eligible for compensation for the listed CPT procedure codes at the network contracted rate, but the presence or absence of a code is not a guarantee of coverage or payment.

Some interventional pain management codes on the list may require prior authorization. Refer to the Spinal Conditions Management Program Prior Authorization Code Matrix administered by National Imaging Associates (NIA) for prior authorization requirements.

Accepted CPT codes

Accepted/Eligible Anesthesia-Related CPT Procedure CodesCPTCovered

20526
20550
20551
20552
20553
20600
20604
20605
20606
20610

1–10 of 127

1/13

Being on this list indicates eligibility for anesthesiologist compensation at the network contracted rate, but it does not guarantee coverage or payment; claims remain subject to member eligibility, benefits, referrals/authorizations, utilization management and claims editing logic. Some interventional pain management codes may require prior authorization through NIA per the separate prior authorization matrix.

Billing, authorization, and documentation requirements

Billing Rule

Compensation at Network Contracted Rate

Anesthesiologists are eligible for compensation for the listed CPT procedure codes at the network contracted rate; presence or absence of a CPT procedure code is not a guarantee of coverage or payment.

Eligibility/payment not guaranteed

Prior Authorization

Prior Authorization for Certain Interventional Pain Codes

Interventional pain management codes may be subject to prior authorization through National Imaging Associates per the Spinal Conditions Management Program Prior Authorization Code Matrix; providers must refer to that matrix for PA requirements.

Refer to NIA Spinal Conditions Management Program Prior Authorization Code Matrix for PA requirements.

Documentation Required

Claims Subject to Member Eligibility and Plan Rules

Claims payment is subject to member eligibility and benefits on the date of service, coordination of benefits, referral/authorization, utilization management guidelines, adherence to plan policies and claims editing logic; providers should document accordingly.

Verify member eligibility and benefits on date of service
Check coordination of benefits
Confirm required referral or authorization
Follow utilization management guidelines where applicable
Adhere to plan policies and claims editing logic