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TRICARE Policy Manual 6010.63-M, April 2021
Chapter 11
Section 3.5
Anesthesiologist Assistant (AA)
Issue Date:  January 23, 1984
AAs are highly skilled allied health professionals who work under the direction of licensed anesthesiologists to develop and implement anesthesia care plans. AAs work exclusively within the anesthesia care team environment as described by the American Society of Anesthesiologists (ASA). All AAs possess a premedical background, a baccalaureate degree, and also complete a comprehensive didactic and clinical program at the graduate school level. AAs are trained extensively in the delivery and maintenance of quality anesthesia care as well as advanced patient monitoring techniques.
The following criteria must be met for coverage of anesthesia services by an AA:
2.1  The AA works under the direct supervision of an anesthesiologist who bills for the services. In addition, for each patient the anesthesiologist must:
2.1.1  Perform a pre-anesthetic examination and evaluation;
2.1.2  Prescribe the anesthesia plan;
2.1.3  Personally participate in the most demanding aspects of the anesthesia plan including, if applicable, induction and emergence;
2.1.4  The anesthesiologist ensures that any procedures in the anesthesia plan that he or she does not perform are performed by a qualified AA.
2.1.5  Monitor the course of anesthesia administration at frequent intervals;
2.1.6  Remain physically present and available for immediate personal diagnosis and treatment of emergencies. While it is not necessary that the anesthesiologist be personally present for all services, the anesthesiologist must be within the operating suite and available to provide immediate assistance.
2.1.7  Provide indicated post anesthesia care; and
2.1.8  Perform no other services while he or she supervises no more than four AAs concurrently. If the state where the service is provided limits anesthesiologists to supervising fewer than four AAs concurrently, the limit established by the state is to be used.
2.2  The AA is in compliance with all applicable requirements of state law, including any licensure requirements the state imposes on nonphysician anesthetists.
2.3  The AA is a graduate of a Master’s level anesthesiologist assistant educational program that is established under auspices of an accredited medical school and that:
2.3.1  Is accredited by the Commission on Accreditation of Allied Health Educational Programs (successor organization to the Committee on Allied Health Education and Accreditation, or its successor organization; and
2.3.2  Includes approximately two years of specialized basic science and clinical education in anesthesia at a level that builds on a premedical undergraduate science background.
May 21, 2004.
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