The following frequently asked questions (FAQ) were developed to answer questions about Independence Blue Cross?s (Independence) new position regarding reimbursement for anesthesia physical status modifiers as outlined in Claim Payment Policy #00.01.14q: Reporting and Documentation Requirements for Anesthesia Services.
Note: This document will be updated as additional information becomes available.
1. Why has Independence updated its reimbursement position for anesthesia physical modifiers for commercial members?
We have updated our reimbursement position for anesthesia physical status modifiers based on the positions of the Centers for Medicare & Medicaid Services (CMS) and Independence?s Medicare Advantage Benefit Program. Both CMS and Independence (for Medicare Advantage plans) do not recognize or issue additional reimbursement for anesthesia physical status modifiers P3, P4, and P5.
2. What are anesthesia physical status modifiers?
A physical status modifier may be appended to an anesthesia claim to indicate the health condition of the patient. Physical status modifiers range from P1 ? P6. Per the American Society of Anesthesiologists (ASA) Relative Value Guide, the modifiers are described as follows:
- P1 (Normal healthy patient)
- P2 (Mild systemic disease)
- P3 (Severe disease)
- P4 (Disease a threat to life)
- P5 (Moribund patient)
- P6 (organ donor)
3. What is the effective date of this change?
Claim Payment Policy #00.01.14q: Reporting and Documentation Requirements for Anesthesia Services, which implements this change for commercial members, is effective for Independence claims beginning/received on or after January 1, 2019.
4. Which providers will be impacted by this update?
This change will affect all providers who bill anesthesia ASA procedure codes for Independence members.
5. How have providers been notified of the change to the anesthesia physical status modifiers?
On October 1, 2018, this policy change was announced to providers via:
For more information
Please refer to the Medical Policy Portal to view the most recent version of this policy, as it supersedes the information in this FAQ.
If you cannot find the information you are looking for here and have further questions, please email us at anesthesiamodifiers@ibx.com. Be sure to include your name, contact number, and provider ID number in your email.
You can download a PDF of this FAQ here.
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