- Anesthesia Billing Guide
- Anesthesia Billing Codes
- Anesthesia Billing Modifiers
- Anesthesia
- Concurrent, Medical Direction and Supervision
- Daily Management and Pain Management
- Group/Member Practice Responsibilities
- Local Coverage Determinations
- Moderate (Conscious) Sedation
- Monitoring Anesthesia Services
- National Coverage Determinations
- Payment and Reimbursement
- Provider Qualifications
- Teaching Anesthesiology Services
- Resources and References
- Related Articles
National Coverage Determinations
General
Medicare coverage is limited to items and services that are reasonable and necessary for the diagnosis or treatment of an illness or injury (and within the scope of a Medicare benefit category).
NCDs are made through an evidence-based process, with opportunities for public participation. In some cases, CMS' own research is supplemented by an outside technology assessment and/or consultation with the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC).
In the absence of an NCD, an item or service may be covered at the discretion of the Medicare contractors based on an LCD.
NCD for Anesthesia for Cardiac Pacemaker Surgery (10.6)
The use of general or monitored anesthesia during cardiac transvenous pacemaker surgery may be reasonable and necessary if documentation supports medical necessary; medical coverage is determined on a case-by-case basis. Obtain advice from the appropriate Medical Review departments (CMRA, MRAD, etc.) regarding the adequacy of documentation before deciding whether a particular claim should be covered.
A second type of pacemaker surgery that is sometimes performed involves the use of the thoracic method of implantation, which requires open surgery. Where the thoracic method is employed, general anesthesia is always used and should not require special medical documentation.
Reviewed 11/16/2023