Reimbursement policy update: Professional Anesthesia Service

Beginning with dates of service on or after November 1, 2024, Anthem will update the Anesthesia Modifiers list in the Related Coding section of the Professional Anesthesia Service reimbursement policy with the following:

• Updated modifier QZ reimbursement from 100% to 85%.
• Added modifiers QK, QX, or QY language (removed from the policy body section).
• Removed diagnosis codes not eligible for reimbursement when reported with add-on code 99140 code list.
• Added the following statement to the Comments column for modifiers G8, G9, and QS comment column:
  • May be reported in a subsequent modifier field when the service rendered is monitored anesthesia care (MAC).
• Updated physical status modifiers P3, P4, and P5 language to indicate reimbursement for the applicable additional time unit.

Section V., Qualifying Circumstances for Anesthesia will be updated to indicate that Anthem will consider qualifying circumstances to be always bundled when reported in addition to the anesthesia procedure or service provided.

The policy has been renamed to Anesthesia Services — Professional. For specific policy details, visit the Maine reimbursement policy page at tinyurl.com/4efrmynn.