Anthem to Reduce CRNA Payment

This summer, Anthem—the Blue Cross/Blue Shield (BCBS) carrier for several states (California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin)—published an updated Anesthesia Services policy, with an effective date of November 1, 2024. The new policy statement contains language that will negatively affect reimbursement rates for many anesthesia practices. Here are the details:

1. While medically directed rates generally remain unaffected, cases involving non-medically directed CRNAs will be paid at 85 percent of the allowable, rather than 100 percent.

2. While extra payment is still available for physical status modifiers P3, P4 and P5, qualifying circumstances will not be reimbursed. These circumstances include:

• 99100 Anesthesia for patient younger than 1 year and older than 70
• 99116 Anesthesia complicated by utilization of the total body hypothermia
• 99135 Anesthesia complicated by utilization of controlled hypotension
• 99140 Anesthesia complicated by emergency conditions

3. Anthem points out the following exceptions to the above payment policies in connection with the following states:

• CO – No reduction in QZ payment
• GA – No reduction in QZ payment; continues payment for qualifying circumstances
• IN – No reduction in QZ payment
• KY – No reduction in QZ payment; continues payment for qualifying circumstances
• NH – No reduction in QZ payment
• WI – No reduction in QZ payment

Coronis Health will continue to monitor Anthem policy announcements in the eventuality that these planned reductions to payment are rescinded or expanded and will update you accordingly.