Aetna will no longer provide additional payment for physical status modifier 3-5 on anesthesia claims, according to an April 19 post by medical revenue cycle management group Coronis Health.
Effective July 15, Aetna's commercial plans will stop reimbursing additional unit values for anesthesia physical status modifiers.
In January, Aetna announced it would no longer reimburse additional unit values for anesthesia physical status modifiers for all its Medicare Advantage Plans to align with CMS guidelines. This update went into effect April 8.
Some anesthesia leaders are unhappy with the move and how it could affect patients and providers.
"Physical status modifiers have been part of commercial insurance payments for decades and reflect the challenges associated with providing anesthesia services to patients with the greatest severity of medical conditions," American Society of Anesthesiologists President Ronald Harter, MD, told Becker's in a statement. "This could adversely affect the care provided to these insurers' most medically complex patients."
"Medicare acknowledges the importance of assessing patients' complex medical conditions," Dr. Harter added — referencing how Medicare approved an HCPCS add-on code that pays primary care physicians more for providing care to complex patients.
According to the Coronis post, Blue Cross Blue Shield of Illinois, New Mexico, Oklahoma, Texas and Montana have made recent revisions to their anesthesia policies that contain a note that physical status modifiers are not utilized to determine payment for anesthesia services. The report cites a recent BCBS of New Mexico policy that states the payer "will no longer offer additional reimbursement for services based on the use of physical status modifiers when appended to anesthesia services."
"By ceasing to recognize the medical complexity of patients requiring anesthesia care, BCBS and Aetna are moving away from patient-centered care, placing profits over patients." Dr. Harter said.
"Aetna will no longer reimburse additional unit value for Anesthesia Physical Status Modifiers for Aetna commercial plans," an Aetna spokesperson confirmed to Becker's. "This change became effective for Aetna Medicare Advantage on April 1, 2024, which is in accordance with the Centers for Medicare & Medicaid Services (CMS) guidelines."