Military Health System

3.1  Postoperative pain management consisting mainly of the intramuscular (IM) and/or intravenous (IV) administration of patient controlled analgesia (PCA) is considered a part of the global charge for the surgery. The administration of epidural analgesia is a specialized technique that can only be provided by a specially trained physician. It includes the following services:

3.2  Since postoperative epidural analgesia care represents a level of services above that of routine postoperative pain relief provided by physicians, it is allowed outside the global surgical fee subject to the following reimbursement guidelines.

4.1  Payment of postoperative pain management outside the global surgical fee is only allowed for epidural analgesia care provided and billed by a physician. TRICARE will pay the physician for:

4.2  The physician is only allowed to bill one pain management procedure code (CPT code 01996) per day. The procedure includes all visits and contacts during the 24-hour time period to adjust the dosage and to maintain a functioning catheter.

4.3  Daily hospital management of epidural drug administration will be paid up to three calendar days following the day of surgery. Additional management services may be allowed at the discretion of the contractor based on the managing physician’s recommendation.