OHCA Policies and Rules

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Part       ANESTHESIOLOGIST ASSISTANTS

317:30⊂chapter=5∂=70--612.Eligible providers
[Issued 07-01-09]
Payment is made directly to Anesthesiologist Assistants (AA) for compensable anesthesia services within their scope of practice under state law. The AA must be licensed to practice under applicable state laws. In addition, the AA must have a current provider contract on file with the Oklahoma Health Care Authority (OHCA).
317:30⊂chapter=5∂=70--613.Coverage by category

[Issued 07-01-09]
Payment is made to Anesthesiologist Assistants as set forth in this Section.
(1) Adults. Payment is made for the administration of anesthesia to adults within the scope of the Authority's medical programs, provided the services are reasonable and necessary for the treatment of illness or injury, or to improve the functioning of a malformed body member.
(2) Children. Coverage for children is the same as for adults.
(3) Individuals eligible for Part B of Medicare. Payment is made utilizing the Medicaid allowable for comparable services.

317:30⊂chapter=5∂=70--614.Billing instructions
[Issued 07-01-09]
The AA is responsible for entering the correct anesthesia procedure code on the appropriate claim form. Anesthesia codes from the Physicians' Current Procedural Terminology or Medicare assigned codes should be used.
(1) Payment is made only for the major procedure during an operative session.
(2) All anesthesia procedure codes must have a modifier. Without the modifier, the claim will be denied. Payment is made to an AA for services provided under the direct supervision of a licensed anesthesiologist and is limited to 50% of the physician allowable using modifier QX. 
(3) Certain codes in the Medicine section of the CPT are used to identify extraordinary anesthesia services. Additional payment can be made when applicable for extremes of age, total body hypothermia and controlled hypertension.
(4) All other qualifying circumstances, i.e., physical status, emergency, etc., have been structured into the total allowable for the procedure.
(5) Hypothermia total body or regional is not covered unless medical necessity is documented and approved through review by the Authority's Medical Consultants.
(6) Payment for placement of central venous catheter, injection of anesthesia substance or similar procedures will be made only when the procedure is distinctly separate from the anesthesia procedure.
317:30⊂chapter=5∂=70--615.Payment methodology
[Issued 07-01-09]
Payment to the AA is limited to 50% of the physician allowable for anesthesia services.  

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.