Anesthesia Coding Alert

Answer: Yes, this is true. According to Florida’s Statewide Medicaid Managed Care (SMMC) policy transmittal 2020-59, “Effective December 1, 2020, the managed care plan must reimburse hospital-based specialty providers at the MPIP enhanced rates for services rendered to enrollees under the age of twenty-one (21) years, regardless of whether the physician is part of the managed care plan’s network. Hospital-based specialty physicians include medical doctors and doctors of osteopathic medicine who practice in one of the following specialties and render the majority of all the specialty services they provide in an inpatient hospital setting (place of service code 21) or emergency room – hospital (place of service code 23).” Anesthesiology is one of the seven specialties listed.

Bottom line: Managed Medical Assistance (MMA) Physician Incentive Program (MPIP) payment rates must equal or exceed Medicare rates for certain services provided. In Florida, that means SMMC should be paying rates ranging from $21.51 to $23.26, depending on geographical location, instead of $15.08. That’s a difference of up to $8.18 per unit! Anesthesia providers welcomed this news, as they are already challenged with being underpaid by the Medicare program when compared to commercial rates.

Resources: Check out information on this regulatory change in Florida at https://ahca.myflorida.com/Medicaid/statewide_mc/ pdf/2018-23_plan_comm/PT_2020-59_MPIP_Requirements_ Year-5_11.12.2020.pdf, https://medicare.fcso.com/Fee_news/0500075.asp, and https://ahca.myflorida.com/medicaid/review/ Reimbursement/2022-07_Fee_Schedules/Practitioner_Fee_ Schedule_2022_July.pdf.