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SERVICE FEE MEMORANDUM
MS-CE-01-02-26

DATE: July 8, 2002
RE: RVS Anesthesiology Guidelines and Chart

The following two pages contain updated information regarding the Relative Value Schedule (RVS)
 Anesthesiology Guidelines and Time Chart.

Please replace Page 94 (hard copy) of the RVS with these two pages, 94A and 94B. For those staff who do
not maintain a hard copy of the RVS, this information may be saved in Microsoft Word for future reference.

Regarding the Time Chart only, this may also be located in the Case Management System:

Click on CMS Central Office;

Then click on Codes;

Cursor down to locate 11200 - Click on Time Values to be added for anesthesia.

SPECIAL CIRCUMSTANCES FOR KENTUCKY DEPARTMENT OF VOCATIONAL REHABILITATION (DVR)/DEPARTMENT FOR THE BLIND (DFB)

MEDICAL DIRECTION BY ANESTHESIOLOGIST; ADMINISTRATION BY CRNA

The anesthesiologist may medically direct no more than four concurrent anesthesia cases (AdminaStar Federal Anesthesia Policy Manual). The anesthesiologist should ordinarily not be involved in furnishing additional 
services to other patients. When student nurse anesthetists are involved, only two concurrent cases can be 
medically directed. If the anesthesiologist leaves the immediate area of the operating suite for other than short 
durations, devotes extensive time to an emergency case or is otherwise not available to respond to the 
immediate needs of the surgical patient, his or her services to the surgical patients are supervisory in nature 
and payment would not be appropriate because medical direction could not be provided. An anesthesiologist’s 
medical direction of anesthesia administration performed by a Certified Registered Nurse Anesthetist (CRNA), Anesthesiologist Assistant (AA), residents and interns, and student nurse anesthetists can be covered.

REIMBURSEMENT RATES

Anesthesiologist for Medical Direction: Total Units x Conversion Factor x 50%
CRNA or AA Administering Anesthesia Under Medical Direction: Total Units x  
                                                                           Conversion Factor x 50%

Residents, Interns, and Student Nurse Anesthetist: No reimbursement

MEDICAL SUPERVISION BY ANESTHESIOLOGIST; ADMINISTRATION BY CRNA
Anesthesia may be administered by a CRNA who is under the supervision of the operating practitioner or of an anesthesiologist who is immediately available if needed (Federal Register). KY Nursing Law allows the 
CRNA to enter into a collaborative effort with the operating physician.

REIMBURSEMENT RATES

Supervising Physician: No reimbursement

CRNA: Total Units x Conversion Factor (100%)

CALCULATIONS OF TOTAL ANESTHESIA VALUES FOR KY DVR/DFB

The total anesthesia value is calculated by adding the separately listed basic value, modifier value(s),
 and time value.

A basic value is listed for most procedures. This includes the value of all usual anesthesia services except
 the value of the actual time spent in anesthesia care and the modifying factors. When multiple surgical 
procedures are performed during a single anesthesia administration, only the greater basic value of the
 various surgical procedures is used.

A physical status modifier is reported for all anesthesia services. The value of the physical status modifier 
and other optional modifiers is added to the basic value.

The time value is computed by allowing 1.0 unit for each 15 minutes of anesthesia time for the first four 
hours and, thereafter by allowing 1.0 unit for each 10 minutes of anesthesia time. In each instance, 5 minutes 
or greater is considered a significant portion of a time unit.

Anesthesia time begins when the anesthesiologist physically begins to prepare the patient for the induction 
of anesthesia in the operating room (or its equivalent) and ends when the anesthesiologist is no longer in 
personal attendance (when the patient may be safely placed under post operative supervision). Duration of 
anesthesia time must be reported.

94A

The following chart identifies units of time for anesthesia:

Unit Value                                  Time                             Unit Value                                     Time

1                                                 15 minutes                       21                                       4 hours, 50 minutes

2                                                  30 minutes                      22                                        5 hours

3                                                  45 minutes                      23                                        5 hours, 10 minutes

4                                                  1 hour                               24                                       5 hours, 20 minutes

5                                                   1 hour, 15 minutes           25                                        5 hours, 30 minutes

6                                                   1 hour, 30 minutes            26                                   5 hours, 40 minutes

7                                                     1 hour, 45 minutes                27                                  5 hours, 50 minutes

8                                                      2 hours                                28                                     6 hours

9                                                      2 hours, 15 minutes              29                                       6 hours, 10 minutes

10                                                    2 hours, 30 minutes              30                                     6 hours, 20 minutes

11                                                  2 hours, 45 minutes                 31                                    6 hours, 30 minutes

12                                                 3 hours                                      32                                   6 hours, 40 minutes

13                                                3 hours, 15 minutes                  33                                  6 hours, 50 minutes

14                                            3 hours, 30 minutes                      34                                  7 hours

15                                             3 hours, 45 minutes                    35                                 7 hours, 10 minutes

16                                              4 hours                                         36                                7 hours, 20 minutes

17                                              4 hours, 10 minutes                      37                                7 hours, 30 minutes

18                                           4 hours, 20 minutes                        38                                    7 hours, 40 minutes

19                                           4 hours, 30 minutes                       39                                     7 hours, 50 minutes

20                                          4 hours, 40 minutes                       40                                      8 hours

 

Over 8 hours

Unit Value                       Time                   Unit Value              Time Unit            Value Time

41                    8                 10                         52        10                               64             12

42                   8                  20                         53          10      10                  65             12            10

43                   8                  30                         54          10      20                  66             12               20

44                   8                  40                         55          10       30                 67             12               30

45                   8                  50                        56           10        40                68              12             40

46                  9                                              57           10          50               69               12            50

47                 9                  10                          58           11                             70              13

48                9                   20                          59            11           10            71                 13              10

49               9                    30                           60            11           20             72               1 3                20

50               9                    40                            61             11         30             73                13                30

51               9                     50                            62             11           40         74                13              40

                                                                          63               11         50           75                13             50

Copyright 1986, Kentucky Department of Vocational Rehabilitation

94B

 

 

 

SERVICE FEE MEMORANDUM

MS-CE-01-02-20
DATE: June 6, 2002

 

RE: Relative Value Schedule Updates

EVALUATION AND MANAGEMENT SECTION

99201-99205 Office Visits – New Patient

For Initial Evaluations of DFB/DVR consumers, many physicians use/bill CPT procedures for New Patient Office Visits rather than CPT procedures for Initial Consultations. The fees that were established for Initial Consultation Procedures 99241-99245 are therefore being adopted for the New Patient Office Visit Procedures 99201 – 99205.

MEDICINE SECTION
90801-90899 Psychiatry

The allowable fee for a Psychiatric Evaluation 90801 has been increased to $140.00. Authorize 90801 when the vendor is a psychiatrist. Authorize from the Psychological Fee Schedule when the vendor is a psychologist or social worker.

 

MEDICINE SECTION (Continued)

 

Psychiatric Therapeutic procedures 90842, 90843, and 90844 have been deleted and replaced with procedures 90804, 90805, 90806, 90807, 90808, and 90809. For 90842, use 90808 or 90809. For 90843, use 90804 or 90805. For 90844, use 90806 or 90807. Procedures 90804, 90806, and 90808 cover Individual Psychotherapy, Insight Oriented, Behavior Modifying and/or Supportive, in an Office or Outpatient Facility. Procedures 90805, 90807, and 90809 cover Individual Psychotherapy, Insight Oriented, Behavior Modifying and/or Supportive, in an Office or Outpatient Facility with Medical Evaluation and Management Services. Please reference the CMS for allowable fees. Authorize these RVS procedures when the vendor is a psychiatrist. Authorize from the Psychological Fee Schedule when the vendor is a psychologist or social worker.

MEDICINE SECTION

Special Otorhinolaryngologic

92589 - Central Auditory Processing (CAP)

A Global Fee of $210.00 has been established for Procedure 92589 - Central Auditory Processing (CAP) assessment. DVR/DFB will allow either the flat fee of $210.00 or the vendor’s usual and customary charge when the vendor’s charge is less.

PRINTING UPDATES SECTIONS OF THE RVS FROM THE CMS

Here are instructions provided by Mary Ann Evans:

Click on CMS Central Office
Click on Reports
Click on Relative Value Printout
Select the Relative Value Type
Click on Print (The Relative Value Report for the selected Relative Value Type will appear on the screen)

TO PRINT
Click on the printer icon
Click OK to print the entire section OR designate the pages that you want to print and Click on OK.