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Starting in February 2025, patients in New York, Connecticut, and Missouri may need to pay out of pocket for anesthesia during surgeries if the procedure exceeds a certain time limit. This change is part of a new policy by Anthem Blue Cross Blue Shield, as reported by the American Society of Anesthesiologists (ASA).
The policy will not affect patients under 22 years old or those receiving maternity-related care. Anthem will use the Centers for Medicare & Medicaid Services (CMS) Physician Work Time values to determine the number of minutes covered for anesthesia services. If the reported time surpasses the CMS-established limit, Anthem will only cover up to that amount.
The ASA has emphasized that billing for pre- and post-operation times must be documented according to their guidelines. Anthem's update does not alter the industry standard coding requirements or the ASA anesthesia formula.
Patients and providers who disagree with a reimbursement decision can follow the claim dispute process outlined in the provider manual. Documentation supporting the request will be necessary.