Policy Updates Reimbursement PoliciesCommercialAugust 1, 2024

Material adverse change

Reimbursement policy update: Professional Anesthesia Service

Beginning with dates of service on or after November 1, 2024, Anthem will update 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 modifiers G8, G9, and QS comment column:
    • May be reported in a subsequent modifier field when the service rendered is monitored anesthesia care (MAC).

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 New York reimbursement policy page at tinyurl.com/27nt7awc.

Commercial services provided by Anthem Blue Cross and Blue Shield, trade name of Anthem HealthChoice HMO, Inc. and Anthem HealthChoice Assurance, Inc., or Anthem Blue Cross and Blue Shield HP, trade name of Anthem HP, LLC.
Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

NYBCBS-CM-063133-24-SRS62776

PUBLICATIONS: August 2024 Provider Newsletter