Anthem Blue Cross Blue Shield has reversed its decision on a controversial anesthesia reimbursement policy update, the payer said in a statement shared with Becker's.
The update, applied to procedures billed under CPT codes 00100 through 01999, would have introduced a new reimbursement structure based on CMS physician work time values. Claims exceeding these predetermined time limits would have been denied.
The payer said that the reversal was spurred from "widespread misinformation" surrounding the update.
Initially announced on Nov. 1, the policy would have taken effect on Feb. 1, 2025, impacting anesthesia claims across Connecticut, New York and Missouri.
The American Society of Anesthesiologists had voiced strong opposition, criticizing the policy’s disregard for the individualized nature of anesthesia care. In a Nov. 14 statement, the ASA warned that Anthem BCBS’s approach would "arbitrarily pre-determine the time allowed for anesthesia care," potentially denying payment for complex or prolonged cases and jeopardizing patient safety.
David Vierra, MD, an anesthesiologist with Providence Medical Group-Napa (Calif.), told Becker's, that the decision would "further deteriorate anesthesia reimbursement, leading to further pressure on hospitals and ASCs to make up the difference, more anesthesiologists leaving medicine and further reductions in access to care."
Anthem faced scrutiny when posts about the policy went viral on X on Dec. 4, prompting policymakers to weigh in. The move sparked controversy when it was released, but outrage erupted following the murder of UnitedHealthcare CEO Brian Thompson, which shifted focus to insurance decisions.
"To be clear, it never was and never will be the policy of Anthem Blue Cross Blue Shield to not pay for medically necessary anesthesia services," Anthem's statement continued. "The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines."
Policymakers in both Connecticut and New York had expressed concern over the policy.
"Last night, I shared my outrage at a plan from Anthem to strip away coverage from New Yorkers who had to go under anesthesia for surgery," New York Gov. Kathy Hochul said in a Dec. 5 statement shared with Becker's. "We pushed Anthem to reverse course and today they will be announcing a full reversal of this misguided policy…Don’t mess with the health and well-being of New Yorkers — not on my watch."