Can Nurse Practitioners Bill for Sedation Services for Pediatric Patients?

Carolyn Buppert, NP, JD

Disclosures

February 21, 2008

Question

At my pediatric facility, nurse practitioners, in collaboration with a physician, provide sedation services for radiologic tests. Currently we are not reimbursed for the sedation aspect of this service. How should we code for these services so that we will be reimbursed?

Response From the Expert

 

Carolyn Buppert, NP, JD
Attorney, Law Office of Carolyn Buppert, PC, Bethesda, Maryland


In general, the reimbursement for sedation is included in the fee paid the physician who performs the test. However, there are Current Procedural Terminology (CPT) codes for moderate sedation services provided by a physician other than the healthcare professional performing the diagnostic test. Moderate sedation is defined by CPT as "a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation."[1]

The codes for billing moderate sedation provided by a physician other than the individual performing the test are 99148, 99149, and 99150. You may find it worthwhile to look into billing these codes. These codes may be used only in a facility. Each code is based on time spent. See CPT for a full description of each code.[1]

The questions you will need to answer (by querying the payers in your area) are:

  • Which payers will reimburse for these codes? Not all will.

  • Will the payer reimburse if a nurse practitioner (NP) performs the sedation? Not all will.

  • What is the reimbursement amount?

In addition, you'll need to ask your physician collaborator whether he or she is billing these codes. It would not be appropriate for a physician collaborator to bill these codes when the service is performed by an NP, but it is possible that some are doing so. Payers will not pay 2 bills for the same service.

If payers will pay these codes when the sedation is delivered by an NP, then the next step is to set up an infrastructure for billing -- ie, develop an encounter form, get the NPs credentialed with the payers, hire a billing firm or train the hospital's billing staff regarding billing these procedures, submit claims, and follow up.

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