Wednesday, September 15, 2010

Anesthesia service denial

Anesthesia Services: Bundling Denials

Denial Reason, Reason/Remark Code(s)
  • B15 - Bundling: Payment adjusted because this procedure/service requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated.
  • CPT code: 99100
Resolution/Resources
  • This code is listed as 'Status B' in the Medicare Physician Fee Schedule Database (MPFSDB), which means that payment for this service is always included in payment for other services performed on the same date that are reimbursed under the Medicare Physician Fee Schedule
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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download