The Anthem Debacle – What Were They Really Going to Do?

On November 1, 2024, Anthem announced plans to use data from a publicly accessible CMS website to limit the maximum anesthesia time claimed for each anesthesia CPT code. The policy noted that any claim submitted with “reported time above the established number of minutes will be denied.”

Importantly, CMS does not limit anesthesia time, nor does it provide any explanation on its website regarding what the data in the spreadsheet actually represents. An official inquiry from the ASA to CMS requesting an explanation of the posted times remains unanswered.

In addition, the Anthem policy falsely claimed that “this update will not change industry standard coding requirements or the American Society of Anesthesiologists’ (ASA) anesthesia formula.” In reality, the Anthem policy would have completely upended long-established, universally accepted standards for filing anesthesia claims.

But how could the anesthesiology community fight back against this unilateral change?

~Gordon Morewood, MD, MBA, FASE, FASA

https://www.asahq.org/quality-and-practice-management/managing-your-practice/timely-topics-in-payment-and-practice-management/anesthesia-payment-basics-series-3-payment-conversion-factors-modifiers

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