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BCBS To Discontinue Physical Status Payments

April 19, 2024

Last week, we sent out a special alert advising our readers of a change in Aetna’s payment policy in connection with physical status (PS) modifiers on anesthesia claims. The payer announced it would no longer provide additional payment for PS 3-5, effective July 15 of this year.

Not to be outdone, several of the “Blues” have recently announced similar plans, but with an even earlier effective date. Blue Cross Blue Shield (BCBS) of Illinois, New Mexico, Oklahoma, Texas and Montana have made recent revisions to their anesthesia policy that now contains the following or similar language: “NOTE: Physical status modifiers are not utilized to determine payment for anesthesia services.” The following excerpt comes from the BCBS of New Mexico policy and is representative of the new stance by the Blues: “Under this revised policy BCBSNM will no longer offer additional reimbursement for services based on the use of physical status (P code) modifiers when appended to anesthesia services.” The policy change is set to take effect on June 1, 2024 in all the above-referenced states.

The American Society of Anesthesiologists (ASA) was quick to condemn the shift in policy and has announced its intention to vigorously fight for its reversal. The ASA may have an uphill battle on its hands as it may be only a matter of time before more of the Blues revise their anesthesia policies to reflect a similar position on PS payment.  Please feel free to contact your account executives if you have questions about this announcement.

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