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Reimbursement Reduction to Anesthesiologists

April 18, 2017

Information posted December 2, 2016

Note: This article applies only to claims submitted to TMHP for processing. Refer to the Medicaid managed care organizations (MCOs) for information about MCO benefits, limitations, prior authorization, reimbursement, and MCO specific claim processing procedures.

Effective January 1, 2017, anesthesiologists directing one or multiple certified registered nurse anesthetists (CRNA) and/or anesthesiologist assistants (AA) during medical procedures will be reimbursed at 75 percent of the established reimbursement rate. This reimbursement change will apply for Texas Medicaid.

These reimbursement reductions are in accordance with the 2016 through 2017, General Appropriations Act, H.B. 1, 84th Legislature, Regular Session, 2015 (Article II, Health and Human Services Commission, Rider 50, Medicaid Funding Reduction and Cost Containment).

Providers can refer to the Texas Medicaid Provider Procedure Manual, Vol 2, Medical and Nursing Specialists, Physicians and Physician Assistants Handbook section 9.2.6, “Anesthesia.”

For more information, call the TMHP Contact Center at 1-800-925-9126.