Anthem Anesthesia Policy Update
September 25, 2024
Effective 11/01/2024 the following highlights will be part of the Anthem Anesthesia Policy Update. There are several areas with a negative impact on reimbursement. Anthem Blue Cross currently is the payer for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, New Hampshire, Ohio, Virginia and Wisconsin.
Highlights of the Anthem Anesthesia Policy Update:
- 15% reduction for claims submitted with a QZ modifier (non-medically directed CRNA)
- Colorado, Georgia, Indiana, Kentucky, Maine, New Hampshire and Wisconsin have an exemption to this rule.
- Connecticut, Ohio, Missouri and Virginia will have QZ claims paid at 85% of their fee schedule.
- No Longer allowing reimbursement for Ancillary services – these codes will now be bundled.
- 99100 (age indicator – under one or over seventy – valued at one base unit).
- 99136 (total body hypothermia – valued at five base units).
- 99135 (controlled hypotension – vlaued at five base units).
- 99140 (emergency indicator – valued at two base units).
- Physical status modifiers will continue to be reimbursed as follows:
- P3 – one additional base unit
- P4 – two additional base units
- P5 Three additional base units
- Line Placements, pain blocks and TEEs will continue to be reimbursed seperately.
- Bundling follow-up E&M services into anesthesia service for post-operative pain management.
- E&M visits for post-operative pain visits will no longer be paid seperately (performed within 10 days from the date of the anesthesia service)
- 01996 for the daily management of a continuous epidural for post-operative pain management will still be paid separately.
- Post-operative pain blocks are still reimbursable.
- Multiple surgeries on the same day subject to review.
The following comes from section III of the policy:
Based on ASA billing guidelines, when anesthesia services are provided for multiple surgical procedures, only the anesthesia code for the most complex service should be reported. Base units are only used for the primary procedure and not for any secondary procedures. If two separate anesthesia codes are reported, the procedure with the lesser charge will be denied. (Exception: add-on codes 01953, 01968 and 01969, which are listed separately in addition to the code for the primary procedure, are eligible for separate reimbursement).
If the Health Plan can determine based on its review of the anesthesia record, that a separate subsequent operative session took place with more than an hour separation from the initial anesthesia, the second subsequent anesthesia service may be considered eligible for separate reimbursement.
