11-02 FEE SCHEDULE FOR PHYSICIANS’ SERVICES 15016 (Cont.) The special payment limitation in §15044 is not applied. If payment is made on the basis of a single team fee, deny additional claims. Determine which procedures performed in your service area require a team approach to surgery. Team surgery is paid for on a "By Report" basis. The services of physicians of different specialties may be necessary during surgery when each specialist is required to play an active role in the patient's treatment because of the existence of more than one medical condition requiring diverse, specialized medical services. For example, a patient's cardiac condition may require that a cardiologist be present to monitor the patient's condition during abdominal surgery. In this type of situation, the physician furnishing the concurrent care is functioning at a different level than that of an assistant at surgery, and payment is made on a regular fee schedule basis. 15018. PAYMENT CONDITIONS FOR ANESTHESIOLOGY SERVICES. General Payment Rule.--The fee schedule amount for physician anesthesia services furnished on or after January 1, 1992 is, with the exceptions noted, based on allowable base and time units multiplied by an anesthesia conversion factor specific to that locality. The base unit for each anesthesia procedure is listed in subsection K, Exhibit 1. The way in which time units are calculated is described in subsection G. Do not allow separate payment for the anesthesia service performed by the physician who also furnishes the medical or surgical service. In that case, payment for the anesthesia service is made through the payment for the medical or surgical service. For example, do not allow separate payment for the surgeon’s performance of a local or surgical. 15-2.6 Rev. 1780
11-02 FEE SCHEDULE FOR PHYSICIANS’ SERVICES 15016 (Cont.) The special payment limitation in §15044 is not applied. If payment is made on the basis of a single team fee, deny additional claims. Determine which procedures performed in your service area require a team approach to surgery. Team surgery is paid for on a "By Report" basis. The services of physicians of different specialties may be necessary during surgery when each specialist is required to play an active role in the patient's treatment because of the existence of more than one medical condition requiring diverse, specialized medical services. For example, a patient's cardiac condition may require that a cardiologist be present to monitor the patient's condition during abdominal surgery. In this type of situation, the physician furnishing the concurrent care is functioning at a different level than that of an assistant at surgery, and payment is made on a regular fee schedule basis. 15018. PAYMENT CONDITIONS FOR ANESTHESIOLOGY SERVICES. General Payment Rule.--The fee schedule amount for physician anesthesia services furnished on or after January 1, 1992 is, with the exceptions noted, based on allowable base and time units multiplied by an anesthesia conversion factor specific to that locality. The base unit for each anesthesia procedure is listed in subsection K, Exhibit 1. The way in which time units are calculated is described in subsection G. Do not allow separate payment for the anesthesia service performed by the physician who also furnishes the medical or surgical service. In that case, payment for the anesthesia service is made through the payment for the medical or surgical service. For example, do not allow separate payment for the surgeon’s performance of a local or surgical. 15-2.6 Rev. 1780