Description
Claims for anesthesia services billed under HCPCS code 01992 will be denied when reported on the same date of service for the same beneficiary as spinal pain management procedures, including facet joint injections, facet joint denervation, and epidural steroid injections, in accordance with MAC policies and FPS83 guidelines.
Affected Code(s)
01992
Applicable Policy References
1. Social Security Act (SSA), Title XVIII - Health Insurance for the Aged and Disabled, Section 1862(a)(1)(A) - Exclusions from Coverage and Medicare as a Secondary Payer
2. Social Security Act (SSA), Title XVIII - Health Insurance for the Aged and Disabled, Section 1833(e) - Payment of Benefits
3. 42 CFR §405.929 - Post-Payment Review
4. 42 CFR §405.930 - Failure to Respond to Additional Documentation Request
5. 42 CFR §405.980 - Reopening of Initial Determinations, Redeterminations, Reconsiderations, Decisions, and Reviews, (b)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Initiated by a Contractor; and (c)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Requested by a Party
6. 42 CFR §405.986 - Establishing Good Cause for Reopening
7. 42 CFR §414.40 - Coding and ancillary policies
8. 42 CFR §414.46 - Additional rules for payment of anesthesia services.
9. 42 CFR §415.110 - Conditions for payment: Medically directed anesthesia services.
10. 42 CFR §415.170 - Conditions for payment on a fee schedule basis for physician services in a teaching setting.
11. 42 CFR §415.178 - Anesthesia services.
12. 42 CFR §482.52 - Condition of participation: Anesthesia services.
13. Medicare Program Integrity Manual, Chapter 3- Verifying Potential Errors and Taking Corrective Actions, §§3.1-3.6.6
14. Medicare Claims Processing Manual, Chapter 12- Physicians/Non-physician Practitioners, §20.3- Bundled Services/Supplies, §30- Correct Coding Policy, §40- Surgeons and Global Surgery, §50- Payment for Anesthesiology Services, §140.3 - Anesthesia Fee Schedule Payment for Qualified Nonphysician Anesthetists, §140.4 - Qualified Nonphysician Anesthetist Special Billing and Payment Situations
15. Medicare NCCI Coding Policy Manual- Chapter 1; General Correct Coding Policies; G. Anesthesia Services Included in the Surgical Procedure
16. Medicare NCCI Coding Policy Manual – Chapter 2; Anesthesia Services; CPT Codes 00000-01999; B. Standard Anesthesia Coding
17. Medicare NCCI Coding Policy Manual- Chapter 4; Surgery: Musculoskeletal System; C. Anesthesia
18. Medicare NCCI Coding Policy Manual- Chapter 8; Surgery: Endocrine, Nervous, Eye and Ocular Adnexa, and Auditory Systems; C. Nervous System
19. CMS Anesthesia Conversion Factors and Base units are available at: Anesthesiologists Center | CMS
20. CGS Administrators, LLC, Local Coverage Determination (LCD) L39383- Sacroiliac Joint Injections and Procedures; Effective: 3/19/2023
21. CGS Administrators, LLC, Local Coverage Article (LCA) A59154- Billing and Coding: Sacroiliac Joint Injections and Procedures; Effective 3/19/2023
22. National Government Services, Inc., Local Coverage Determination (LCD) L39455- Sacroiliac Joint Injections and Procedures; Effective 3/19/2023; Revised 08/10/2023
23. National Government Services, Inc., Local Coverage Article (LCA) A59233- Billing and Coding: Sacroiliac Joint Injections and Procedures; Effective 3/19/2023; Revised 01/25/2024
24. Wisconsin Physicians Service Insurance Corporation, Local Coverage Determination (LCD) L39475- Sacroiliac Joint Injections and Procedures; Effective 3/19/2023; Revised: 12/26/2024
25. Wisconsin Physicians Service Insurance Corporation, Local Coverage Article (LCA) A59257- Billing and Coding Sacroiliac Joint Injections and Procedures 03/19/2023; Revised 12/26/2024
26. Noridian Healthcare Solutions, LLC, Local Coverage Determination (LCD) L39462- Sacroiliac Joint Injections and Procedures; Effective 03/19/2023
27. Noridian Healthcare Solutions, LLC, Local Coverage Article (LCA) A59244- Billing and Coding: Sacroiliac Joint Injections and Procedures; Effective 03/19/2023; Revised: 06/01/2024
28. Noridian Healthcare Solutions, LLC, Local Coverage Determination (LCD) L39464- Sacroiliac Joint Injections and Procedures; Effective: 03/19/2023
29. Noridian Healthcare Solutions, LLC, Local Coverage Article (LCA) A59246- Billing and Coding: Sacroiliac Joint Injections and Procedures; Effective: 03/19/2023; Revised: 06/01/2024
30. Palmetto GBA, Local Coverage Determination (LCD) L39402- Sacroiliac Joint Injections and Procedures; Effective: 03/19/2023; Revised: 11/28/2024
31. Palmetto GBA, Local Coverage Article (LCA) A59192- Billing and Coding: Sacroiliac Joint Injections and Procedures; Effective: 03/19/2023; Revised: 10/18/2024
32. CGS Administrators, LLC, Local Coverage Determination (LCD) L39015- Epidural Steroid Injection for Pain Management; Effective: 12/05/2021; Revised 11/09/2023
33. CGS Administrators, LLC, Local Coverage Article (LCA) A58731- Billing and Coding: Epidural Steroid Injections for Pain Management; Effective: 12/05/2021
34. National Government Services, Inc., Local Coverage Determination (LCD) L39036- Epidural Steroid Injections for Pain Management; Effective: 12/05/2021; Revised: 11/23/2023
35. National Government Services, Inc., Local Coverage Article (LCA) A58745- Billing and Coding: Epidural Steroid Injections for Pain Management; Effective: 12/05/2021; Revised: 11/23/2023
36. Noridian Healthcare Solutions, LLC, Local Coverage Determination (LCD) L39240- Epidural Steroid Injections for Pain Management; Effective: 06/19/2022
37. Noridian Healthcare Solutions, LLC, Local Coverage Article (LCA) A58993- Billing and Coding: Epidural Steroid Injections for Pain Management; Effective 06/19/2022; Revised: 11/15/2023
38. Noridian Healthcare Solutions, LLC, Local Coverage Determination (LCD) L39242- Epidural Steroid Injections for Pain Management; Effective: 06/19/2022
39. Noridian Healthcare Solutions, LLC, Local Coverage Article (LCA) A58995- Billing and Coding: Epidural Steroid Injections for Pain Management; Effective: 06/19/2022; Revised: 11/15/2023
40. Palmetto GBA, Local Coverage Determination (LCD) L38994- Epidural Steroid Injections for Pain Management; Effective: 12/05/2021; Revised: 11/16/2023
41. Palmetto GBA, Local Coverage Article (LCA) A58695- Billing and Coding: Epidural Steroid Injections for Pain Management; Effective: 12/05/2021; Revised: 11/16/2023
42. Wisconsin Physicians Service Insurance Corporation, Local Coverage Determination (LCD) L39054- Epidural Steroid Injections for Pain Management; Effective: 12/05/2021; Revised: 02/01/2024
43. Wisconsin Physicians Service Insurance Corporation, Local Coverage Article (LCA) A58777- Billing and Coding: Epidural Steroid Injections for Pain Management; Effective:12/05/2021; Revised: 11/30/2023
44. First Coast Service Options, Inc., Local Coverage Determination (LCD) L33906- Epidural Steroid Injections for Pain Management; Effective: 10/01/2015; Revised: 12/12/2021
45. First Coast Service Options, Inc., Local Coverage Article (LCA) A56651- Billing and Coding: Epidural Steroid Injections for Pain Management; Effective: 10/03/2018; Revised: 11/16/2023
46. Novitas Solutions, Inc., Local Coverage Determination (LCD) L36920- Epidural Steroid Injections for Pain Management; Effective: 05/04/2017; Revised: 12/12/2021
47. Novitas Solutions, Inc., Local Coverage Article (LCA) A56681- Billing and Coding: Epidural Steroid Injections for Pain Management; Effective: 07/11/2019; Revised: 11/16/2023
48. CGS Administrators, LLC, Local Coverage Determination (LCD) L38773- Facet Joint Interventions for Pain Management; Effective: 05/02/2021; Revised: 07/07/2024
49. CGS Administrators, LLC, Local Coverage Article (LCA) A58364- Billing and Coding: Facet Joint Interventions for Pain Management; Effective: 05/02/2021; Revised: 07/07/2024
50. First Coast Service Options, Inc., Local Coverage Determination (LCD) L33930- Facet Joint Interventions for Pain Management; Effective: 10/01/2015; Revised: 08/11/2024
51. First Coast Service Options, Inc., Local Coverage Article (LCA) A57787- Billing and Coding: Facet Joint Interventions for Pain Management; Effective: 10/03/2018; Revised: 09/19/2024
52. Noridian Healthcare Solutions, LLC, Local Coverage Determination (LCD) L38801- Facet Joint Interventions for Pain Management; Effective: 04/25/2021; Revised: 07/07/2024
53. Noridian Healthcare Solutions, LLC, Local Coverage Article (LCA) A58403- Billing and Coding: Facet Joint Interventions for Pain Management; Effective: 04/25/2021; Revised: 07/07/2024
54. Noridian Healthcare Solutions, LLC, Local Coverage Determination (LCD) L38803- Facet Joint Interventions for Pain Management; Effective: 04/25/2021; Revised: 07/07/2024
55. Noridian Healthcare Solutions, LLC, Local Coverage Article (LCA) A58405- Billing and Coding: Facet Joint Interventions for Pain Management; Effective: 04/25/2021; Revised: 07/07/2024
56. Novitas Solutions, Inc., Local Coverage Determination (LCD) L34892- Facet Joint Interventions for Pain Management; Effective: 10/01/2015; Revised: 08/11/2024
57. Novitas Solutions, Inc., Local Coverage Article (LCA) A56670- Billing and Coding: Facet Joint Interventions for Pain Management; Effective: 07/11/2019; Revised: 09/19/2024
58. Palmetto GBA, Local Coverage Determination (LCD) L38765- Facet Joint Interventions for Pain Management; Effective: 04/25/2021; Revised: 05/18/2023
59. Palmetto GBA, Local Coverage Article (LCA) A58350- Billing and Coding: Facet Joint Interventions for Pain Management; Effective: 04/25/2021; Revised: 07/07/2024
60. Wisconsin Physicians Service Insurance Corporation, Local Coverage Determination (LCD) L38841- Facet Joint Interventions for Pain Management; Effective: 04/25/2021; Revised: 07/14/2024
61. Wisconsin Physicians Service Insurance Corporation, Local Coverage Article (LCA) A58477- Billing and Coding: Facet Joint Interventions for Pain Management; Effective: 04/25/2021; Revised: 07/14/2024
62. AMA CPT Codebook