On Nov. 1, Anthem Blue Cross Blue Shield Plans representing Connecticut, New York and Missouri announced changes to their evaluation process for claims for anesthesia services.
Here are seven things to know about the billing changes, per news releases from each state's respective Anthem BCBS plan:
1. The changes will affect claims under CPT codes 00100 through 01999 on or after Feb. 1, 2025.
2. Anthem BCBS will use the CMS physician work time values to identify the number of minutes reported for anesthesia services, and claims submitted with reported time over the set number of minutes will be denied.
3. The update will not change industry standard coding requirements or the American Society of Anesthesiologists' anesthesia formula, according to the releases.
4. The update will account for anesthesia minutes included in pre-, intra- and post-service periods. The validity of billing for pre- and post-operation time must be documented and adhere to guidelines established by the ASA.
5. Patients under the age of 22 and maternity-related care will be excluded from the update.
6. The ASA called on Anthem BCBS to reverse this decision in a Nov. 14 statement shared with Becker's. ASA said that anesthesia care is individualized to each patient and that with this new policy, "Anthem will arbitrarily pre-determine the time allowed for anesthesia care during a surgery or procedure," in turn denying those physicians payment for "delivering safe and effective anesthesia care to patients … because their surgery is difficult, unusual or because a complication arises."
7. "This is just the latest in a long line of appalling behavior by commercial health insurers looking to drive their profits up at the expense of patients and physicians providing essential care,” said Donald Arnold, MD, president of ASA. “It's a cynical money grab by Anthem, designed to take advantage of the commitment anesthesiologists make thousands of times each day to provide their patients with expert, complete and safe anesthesia care."