AdministrativeCommercialMedicaidDecember 5, 2024

Material adverse change

Update to anesthesia billed time units policy

We wanted to follow up about the planned updates we previously communicated pertaining to how Anthem evaluates billed time on professional claims for anesthesia services (that is, CPT® codes 00100 through 01999). There has been significant widespread misinformation about an update to our anesthesia policy.

The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines. Any medically necessary anesthesia would have been paid under the update. In circumstances when anesthesia providers went outside of well-established clinical guidelines they would have been able to submit medical documentation to support accurate payment.

Based on feedback received and misinterpretation of our policy change, it is evident that our communication regarding this policy was not clear, and as a result, we have decided to not proceed with this policy change.

Anthem remains highly committed to reducing waste and the cost of care for consumers and ensuring that care providers are reimbursed appropriately for the services provided to members.

If you have questions about this communication or need assistance with any other item, please contact your provider relationship management representative.

Medicaid services provided by Anthem Blue Cross and Blue Shield HP, trade name of Anthem HP, LLC.
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.

PCTS-1093