Medical Fee Schedule: Section 4

In Accordance with the N.C. Industrial Commission’s
Medical Fee Schedule & Subsequent Updates, 1996-2010

Bernadine Singh
Chief Medical Fee Examiner
N.C. Industrial Commission
E-mail: Bernadine.Singh@ic.nc.gov

NOTE 1: To purchase a complete copy of the American Medical Association’s Current Procedural Technology Codes, telephone Ingenix, Inc. at (800) INGENIX (464-3649), option 1, or go to http://www.shopingenix.com/modules/catalog/catalog_category.asp to order a CPT® code book online.

NOTE 2: Please report any problems or errors directly to Bernadine.Singh@ic.nc.gov.

NOTE 3: This page was last revised on June 22, 2010.

TABLE OF CONTENTS

Introduction	CPT Codes and Fees / Commission Assigned Codes
Evaluation and Management Section 3	Physical Medicine Section 10
Anesthesia Section 4 (effective April 1, 2000)	Chiropractic Fee Schedule Section 11 (effective June 22, 2010)
Surgery Section 5	Industrial Rehabilitation Section 12 (effective January 1996)
Radiology Section 6	Dental Fee Schedule Section 13 (effective May 1, 2007)
Pathology and Laboratory Section 7	Hospital and Ambulatory Surgical Center Section 14 (effective July 15, 2002)
Medicine Section 8	Forms Section 16 (effective February 1, 2000)
Special Services Section 9	Durable Medical Equipment/Supply Fee Schedule (effective January 1, 2008)

Anesthesia Section 4

***The following anesthesia codes are to be approved based on fee per minute. (Effective April 1, 2000.)***

NCIC Code	Description	Allowance
ANT01	major, general or spinal, by anesthesiologist (first hour)	$3.88 per minute up to and including 60 minutes
ANT01	major, general or spinal, by anesthesiologist (second hour and subsequent hours)	$2.05 per minute beyond 60 minutes
ANT02	major, general or spinal, by Certified Registered Nurse Anesthetists (first hour)	$2.55 per minute up to and including 60 minutes
ANT02	major, general or spinal, by Certified Registered Nurse Anesthetists (second hour and subsequent hours)	$1.05 per minute beyond 60 minutes

Major, general or spinal anesthesia services should be distinguished by the the use of "Type of Service" code "7" on the CMS (HCFA) 1500 Form, and by the documentation of time (actual minutes) on the bill.

Note to Processors

Unusual monitoring services are not considered part of the basic anesthesia package. Codes 36620-36625 and 93503 are such codes, and may be billed in addition to the "ANT" codes.

When billing for injections or other pain management procedures that are not considered part of a general anesthesia service, the appropriate CPT code should be used and reimbursed accordingly.

Use of CPT code 01996 for daily management of epidural or subarachnoid drug administration is allowed. Reimbursement is $130.00 per day.
There are some items that have no CPT codes, such as any type of supply or minor anesthesia. These items must be entered as CPT code 99070.

N.C. Industrial Commission ·   Medical Fees Section
4337 Mail Service Center ·   Raleigh, NC 27699-4337
Telephone: (919) 807-2503 ·   Fax: (919) 715-0282
NCIC Home Page: http://www.ic.nc.gov/

Medical Fee Schedule: Section 4

In Accordance with the N.C. Industrial Commission’s Medical Fee Schedule & Subsequent Updates, 1996-2010

Anesthesia Section 4

In Accordance with the N.C. Industrial Commission’s
Medical Fee Schedule & Subsequent Updates, 1996-2010