Reimbursement Policy Update: Professional Anesthesia Services

(Policy 06-019)

Anthem Blue Cross and Blue Shield (Anthem) allows reimbursement of anesthesia services rendered by professional providers for covered members. Reimbursement is based upon:

• The reimbursement formula for the allowance and time increments in accordance with state guidelines.
• Proper use of applicable modifiers.

 

For Hoosier Healthwise and Hoosier Care Connect, Anthem currently reimburses anesthesia services personally performed by a certified registered nurse anesthetist (CRNA) submitted with Modifier QZ based on 100% of the applicable fee schedule or contracted/negotiated amount.

 

Effective November 1, 2019, reimbursement for CRNA services submitted with of Modifier QZ will be based on 60% of the applicable fee schedule or contracted/negotiated amount, as identified in the Indiana Health Coverage Programs (IHCP) Anesthesia Services Reference Module.

 

For additional information, refer to the Professional Anesthesia Services reimbursement policy at anthem.com/inmedicaiddoc.