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Revised payment methodology for anesthesiology claims submitted with Modifier GC

Teaching anesthesiologists rendering services in a Method II CAH (also referred to as CAHs that have elected the optional method) have the option of reassigning their billing rights to the CAH. When billing rights are reassigned, the Method II CAH submits an 85x bill type with revenue code 0963 (professional fees for Anesthesiologist (MD)) for payment of the anesthesia services.

Payment is currently calculated for anesthesia services performed by a teaching anesthesiologist with a modifier of GC in a Method II CAH on a 20 percent reduction of the fee schedule amount before deductible and coinsurance are calculated. CR7764 removes the 20 percent reduction that should not be applied in the payment calculation for these services.

Teaching physicians report the GC modifier to indicate that he or she rendered the service in compliance with the teaching physician requirements (Check clm104c12 for more information on the Teaching Physician Requirements). The teaching anesthesiologist should use Modifier AA (Anesthesia services performed by the anesthesiologist) with the GC modifier to report such cases.

Effective for services furnished on or after January 1, 2010, payment may be made under Section 139 of Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) based on the regular fee schedule amount for the teaching anesthesiologist’s involvement in the training of residents in either a single anesthesia case or two concurrent anesthesia cases. CMS also applying this same policy if the teaching anesthesiologist is involved in one resident case that is concurrent to another case that is paid under the medical direction payment rules.

In order for the special payment rule for teaching anesthesiologists to apply, the teaching anesthesiologist (or different anesthesiologists in the same physician group) must be present during all critical or key portions of the anesthesia service. Where different teaching anesthesiologists in the anesthesia group are present during the key or critical periods, the performing physician, for purposes of claims reporting, is the teaching anesthesiologist who started the case. The teaching anesthesiologist (or another anesthesiologist with whom the teaching anesthesiologist has entered into an arrangement) must be immediately available to furnish anesthesia services during the entire procedure.

Reference: http://cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM7764.pdf

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