Anthem, an affiliate of Blue Cross Blue Shield has released its Revised Commercial Reimbursement Policy, Anesthesia Services – Professional, Policy Number: C-09002. Anthem serves California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia, and Wisconsin. Not all Anthem states are impacted due to specific state law. Below is a summary of the changes and what states they apply to.
QZ Modifier Reimbursement
Anthem, an affiliate of Blue Cross Blue Shield has announced that it will no longer reimburse 100% of the fee schedule for non-medically directed CRNA cases effective November 1, 2024. The new rate is now a 15% reduction from the fee schedule.
States Impacted
- California
- Connecticut
- Maine
- Missouri
- Nevada
- New York
- Ohio
- Virginia
Qualifying Circumstances
Anthem will no longer reimburse qualifying circumstances. They identify CPT codes 99100, 99116, 99135, and 99140 as the codes affected by this change and they will be bundled when reported in addition to the anesthesia procedure or service provided.
States Impacted
- California
- Colorado
- Indiana
- Maine
- Missouri
- New Hampshire
- Nevada
- New York
- Ohio
- Virginia
- Wisconsin
How Ventra can help
We will continue to keep you updated on these changes and are always here to assist with any queries you may have. As always, please reach out to your Client Success team if you have any questions.
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