New York Epidural Reimbursement Update

Effective Jan. 1, 2021, our New York Community Plans will disallow separate reimbursement for administration of an epidural or nerve block, either as a component of the anesthesia itself or a post-operative pain management protocol.

This change is to better align with New York state guidelines, which consider this part of the anesthesia time for surgery. This will not be reimbursed as a separate and distinct procedural service when performed by the same provider (or his/her associate) that has provided the anesthesia for the surgical procedure itself. Post-operative visits are included in the total value for anesthesia services. (New York Medicaid Program Physician-Procedure Codes Anesthesia Guidelines, version 2010).

UnitedHealthcare Community Plan Anesthesia Services Policy conflicts with New York Medicaid State requirements by allowing pain management codes to be billed in conjunction with anesthesia service codes, if modifier 59, XE or XU is appended to the pain management code.

Note: Epidurals and nerve blocks performed by Pain clinics or facilities without surgery are out of scope, as they should be paid.