Anthem Blue Cross Blue Shield has made two significant moves this year that anesthesia leaders say will further diminish reimbursements, compounding existing challenges.
Anesthesia reimbursements have been on a steady decline in recent years. Between 2019 and 2024, CMS anesthesia reimbursements dropped 8.2%, falling from $22.27 per unit to $20.44, VMG Health said in a May blog post. An additional report from Coronis Health found that anesthesia providers generating 10,000 billable Medicare units can expect a revenue potential of just $218,000 — assuming all revenue is successfully collected.
Anthem BCBS recently announced another policy change that leaders say will intensify the pressure.
On Nov. 1, Anthem Blue Cross Blue Shield Plans representing Connecticut, New York and Missouri announced that beginning Feb. 1, 2025, the company will revise its evaluation process for anesthesia claims. This change affects claims under CPT codes 00100 through 01999.
Specifically, Anthem BCBS will use CMS physician work time values to determine the number of minutes allowed for anesthesia services. Claims exceeding the predetermined time limits will be denied.
The American Society of Anesthesiologists has strongly opposed the new policy.
In a statement released Nov. 14, the ASA called on Anthem BCBS to reverse its decision, emphasizing the individualized nature of anesthesia care. According to ASA, the new policy means that Anthem BCBS will “arbitrarily pre-determine the time allowed for anesthesia care during a surgery or procedure,” potentially denying payment to anesthesiologists for managing complex or prolonged cases.
“This is just the latest in a long line of appalling behavior by commercial health insurers looking to drive their profits up at the expense of patients and physicians providing essential care,” Donald Arnold, MD, president of ASA, said in the statement. “It’s a cynical money grab by Anthem, designed to take advantage of the commitment anesthesiologists make thousands of times each day to provide their patients with expert, complete and safe anesthesia care.”
Other anesthesiologists echoed the ASA’s concerns.
“I think the Anthem decision to reimburse on CMS average minutes rather than actual minutes will further deteriorate anesthesia reimbursement, leading to further pressure on hospitals and ASCs to make up the difference, more anesthesiologists leaving medicine and further reductions in access to care,” David Vierra, MD, an anesthesiologist with Providence Medical Group-Napa (Calif.), told Becker’s.
In another controversial decision announced earlier this year, Anthem BCBS began reducing reimbursements for certified registered nurse anesthetists under its QZ modifier. Starting Nov. 1, 2024, Anthem BCBS health plans in Ohio, Missouri, Connecticut, New York, Nevada and Maine reimburse QZ services performed by CRNAs at 85% of the physician fee schedule.
These actions by Anthem BCBS are being perceived by many in the anesthesia community as part of a broader effort by insurers to reduce costs at the expense of medical professionals.
“We believe Anthem’s new anesthesia reimbursement policies are in violation of existing federal laws regarding provider nondiscrimination in commercial health plans, encourage higher-cost healthcare delivery without improving quality, and may impair access to care,” the American Association of Nurse Anesthesiology said in an Aug. 6 news release. “AANA urges that Anthem Blue Cross and Blue Shield rescind these policies and promote access to CRNA anesthesia services.”
The AANA has since filed a petition with a U.S. district court compelling Xavier Beccera, Secretary of Health and Human Services, to enforce the provider non-discrimination provision of the Affordable Care Act against insurance companies and health plans.
These moves come amid mounting concerns about the anesthesia provider shortage — a 2024 Medicus white paper forecasts a shortage of 6,300 anesthesiologists by 2036.
Combined with declining CMS reimbursements, anesthesia leaders fear policies threaten to worsen financial challenges and shortages for anesthesia providers, hospitals and ASCs.
