[Provider] Anesthesia billing codes

[Provider Notification]

ATTENTION:  MaineCare Providers Billing Anesthesia Codes 

 

Providers that bill general anesthesiology for non-surgical services
using the code Y9280 have been receiving incorrect reimbursement on some
claims. Y9280 has four (4) base units. 

 

Reminder: For anesthesiology, MaineCare considers 15 minutes equal to
one unit of service.  

 

In order to ensure appropriate payment is made, one of the following
anesthesia modifiers must be entered on the claim: 

 

AA       Anesthesia services performed by anesthesiologist

 

QK      Medical direction of two, three or four concurrent anesthesia
procedures involving qualified individuals   

 

QX      CRNA service with medical direction by a physician 

 

QY      Medical direction of one CRNA by a physician

 

QZ       CRNA Service; without medical direction by a physician

 

 

The claim will be denied if a modifier is not entered. This change will
take place immediately and will include past dates of service, in order
to reduce the number of voids or adjustments that would have to be
filed. 

 

If you believe you have received incorrect payment, it is recommended
claims be voided instead of adjusted since the modifier would need to be
added to the adjusted claims.

            

If you have any questions, please contact Customer Service at
1-800-321-5557, Option 8

 

 

Is your mailing address up to date with MaineCare?  Please keep
MaineCare up to date so your Remittance Statements and checks arrive on
time.  Call Provider Enrollment at 1-800-321-5557 Option #6.  

 

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This is a one-way communication.  Do not reply to this e-mail.  Your
e-mail will not receive response.  If you have questions, please call
1-800-321-5557.  

 

 

 

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