United Healthcare Targets Anesthesia

Yesterday, United Healthcare (UHC) issued a Policy Update Bulletin that will have the effect of reducing reimbursement for anesthesia providers in three key areas. The July Bulletin outlines the following changes:

1. CRNA services will be reduced by 15% when the CRNA is non-medically directed. So, for claims billed out under the QZ modifier, the CRNA will receive 85% of the allowable, instead of 100%. CRNAs in the following states are exempt from this reduction: Arkansas, California, Colorado, Hawaii, Massachusetts, New Hampshire and Wyoming.
2. Units reflecting physical status modifiers 3, 4 and 5 will no longer be reimbursed.
3. Units for qualifying circumstances, as reflected by CPT codes 99100 (age), 99116 (hypothermia), 99135 (hypotension) and 99140 (emergency), will no longer be reimbursed.

These changes will be effective beginning October 1. For some states (Colorado, Kentucky, Ohio and Rhode Island), the effective date will be November 1. Again, while the CRNA reduction will not affect providers in Colorado, the other two changes listed above will go into effect in that state beginning this November.

We have seen this before. There have been a number of recent attempts by big insurance to reduce anesthesia reimbursement, slicing away a bit here and there. However, pushback by the anesthesia community has sometimes been successful in forcing these companies to rescind such plans. It will be up to our readers and anesthesia societies, such as the ASA and others, to make their voices heard by UHC executives concerning these proposed cuts.

We will keep you updated should there be any change in UHC’s position.