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Daily Management of Epidural or Subarachnoid Continuous Drug Administration

Reimbursement Policy:
Daily Management of Epidural or Subarachnoid Continuous Drug Administration

Effective Date:
June 1, 2006

Revision Date:
June 10, 2015

Purpose:
To provide guidelines for reimbursement to participating physicians for daily management of epidural or subarachnoid continuous drug administration.

Scope: 
All products are included, except

  • Products where Horizon BCBSNJ is secondary to Medicare (e.g. Medigap).
  • COB

All Insured and Administrative Service Only (ASO) accounts are included.

Policy:
Horizon BCBSNJ shall reimburse for daily management of epidural or subarachnoid continuous drug administration.

The CPT codes and nomenclature used in this Policy are subject to revision and/or change by the American Medical Association. In the event of such changes, the Policy will continue to be in force, albeit applied to the new or amended coding so issued until such time as the Policy is reviewed and updated to reflect the new or amended coding.

Procedure:
CPT® Code 01996 is classified as a medical code and is reimbursed at the applicable contract/fee schedule rate.

Limitations and Exclusions:
While reimbursement is considered, payment determination is subject to, but not limited to:

  • Group or Individual benefit
  • Provider Participation Agreement
  • Routine claim editing logic, including but not limited to incidental or mutually exclusive logic, and medical necessity
  • Mandated or legislative required criteria will always supersede.

CPT is a registered trademark of the American Medical Association

Policy 001_v2.0_06102015