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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

January 2013

Payment Policy Update: Anesthesiology

Effective for claims processed as of April 1, 2013, when anesthesiologists perform multiple pain management or surgical CPT procedures for the same patient during the same session, Harvard Pilgrim will apply the standard multiple procedure reduction. This change is consistent with the practices of the Centers for Medicare and Medicaid Services (CMS) and aligns Harvard Pilgrim with the industry standard. This policy update does not apply to American Society of Anesthesiologists (ASA) codes, however.

Under the standard multiple procedure reduction policy, when multiple procedures are performed during the same session, the primary procedure is reimbursed at 100% of the allowable rate and all subsequent reimbursable procedures are paid at 50% of the allowable rate. Harvard Pilgrim determines the primary procedure based on the highest allowable rate, not the billed charge.

For more information, please see the updated Anesthesia and Surgery payment policies.

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Eric H. Schultz,
President and Chief Executive Officer

Richard Weisblatt PhD,
Senior Vice President, Provider Network and Product Development

Joann Peck,
Manager, Network Planning and Administration

Annmarie Dadoly,

Kristin Edmonston,
Production Coordinator