AdministrativeCommercialJuly 1, 2024

Anesthesia modifiers — professional editing update

Effective for all claims received on and after August 1, 2024, Anthem is updating its professional claims editing system to deny anesthesia services billed without the required anesthesia modifiers. According to industry-standard coding resources including the American Society of Anesthesiologists and AMA CPT® coding manuals, and the Anthem current commercial professional anesthesia services reimbursement policy, anesthesia modifiers are necessary to identify whether a procedure was personally performed, medically directed, or medically supervised.

The required modifiers to be reported by provider type are as follows:

Provider type
Required modifier(s)

Anesthesiologist

AA, AD, QK, or QY

CRNA or anesthesiologist assistant — medically directed

QX

CRNA — not medically directed

QZ

If you believe you have received a claim denial in error, follow the Anthem claim dispute process.

In Missouri (excluding 30 counties in the Kansas City area): Anthem Blue Cross and Blue Shield is the trade name of RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

MULTI-BCBS-CM-061114-24

PUBLICATIONS: July 2024 Provider Newsletter