01936
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- General Anesthesia or Regional AnesthesiaAdministration of general or regional anesthesia is consideredmedically necessarywhen both of the following criteria are met:
- The services are provided by an individual other than the attending physician performing the procedure;and
- Alternative types of anesthesia, sedation, or analgesia are not appropriate.
- If general or regional anesthesia is requested for a procedure typically not requiring either of these levels of anesthesia service, a medical necessity review will be performed. This review will assess not only the procedure involved, but also other individual-specific issues, such as age, mental status, ability to cooperate, co-morbid conditions, and general medical status.
- Monitored Anesthesia Care (MAC)Monitored anesthesia care (MAC) is consideredmedically necessarywhenallof the following criteria are met:
- MAC is requested by the attending physician;and
2 Active Policies
ANTHEM-CG-MED-21 — CG-MED-21 Anesthesia Services and Moderate (âConsciousâ) Sedation
ANTHEM-CG-MED-78 — CG-MED-78 Anesthesia Services for Interventional Pain Management Procedures
Related Codes
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