Anthem Update: Mark Your Calendars for New Anesthesia Reimbursement Policy on Nov 1, 2024

Last week, Anthem released an update to its commercial reimbursement policy for professional anesthesia services.  Unfortunately for the vast majority of Anthem states the changes will impact many facets of anesthesia reimbursement, scheduled to take place on November 1, 2024. The summary below lists notable reimbursement impacts within the policy.  

Anthem updates anesthesia reimbursement policy

• Modifier QZ, CRNA service without the medical direction of a physician is seeing reimbursement change from 100% to 85%.
  • Colorado, Georgia, Indiana, Kentucky, and Maine are exempt from this reduction. 
• Qualifying circumstances for anesthesia will always be considered bundled.  Previously these add-on codes would reimburse additional units.
  • 99100 – extreme age
  • 99140 – emergency services
  • 99116 – utilization of total body hypothermia
  • 99135 – utilization of controlled hypotension
• Anthem will follow the ASA recommendation for unit values assigned to physical status modifiers P3, P4, and P5. 
• When multiple procedures are performed on the same day only the most complex service will be considered.
  • This does not apply to add-on services for burns and vaginal to c-section or vaginal to hysterectomy codes.
  • This may impact the return to OR services.  The policy states that a review of the records by the health plan may consider additional charges when more than an hour has passed between services.
• Anthem considers E/M services the day before and up to 10 days post-operative to be inclusive.  This 10-day post-operative period includes follow-up for General Anesthesia services and any postoperative pain management supporting the surgical care. This applies to any anesthesia provider that provided the service or another qualified provider that is part of the group.
  • Post-operative pain blocks are still reimbursable based on NCCI guidelines. 
  • Daily hospital management of epidural or subarachnoid catheters that are captured with 01996 are eligible for reimbursement.  All other daily visits for catheter types are not eligible for reimbursement. 
• Transesophageal echocardiograms are stated to be reimbursed following NCCI guidelines outlined in Chapter 2. The policy states it must be performed as an independent procedure from the anesthesia service provided.  The applicable modifiers will need to be assigned for codes in the range 93312-93317.
  • TEEs for monitoring (93318) or guidance during transcatheter cardiac services (93355) are not separately reportable and will not be reimbursed even with an appropriate modifier.