Beginning November 1, 2019, Anthem will reimburse CRNA services submitted with Modifier QZ for their Indiana Medicaid plans at 60 percent of the applicable fee schedule or contracted/negotiated amount.
The new policy aligns Anthem’s Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect plans with other Medicaid payment guidelines that reimburse CRNA services at 60 percent of the allowed amount.
The QZ modifier is used when CRNA services are billed under the anesthesiologist’s National Provider Identifier (NPI), but the physician’s service doesn’t qualify as medical direction. The Centers for Medicare and Medicaid Services recommends using the QZ modifier in “unusual circumstances when it is medically necessary for both the CRNA and the anesthesiologist to be completely and fully involved during a procedure.” In this case, the physician would report using the “AA” modifier and the CRNA would use “QZ.” Each would receive the maximum reimbursement for their provider type.
Prior to implementation of the new policy, Anthem paid CRNA services with a QZ modifier at 100 percent of the applicable fee schedule or contracted/negotiated amount.
For more information, review the following resources:
- Anthem’s Reimbursement Policy Update: Professional Anesthesia Services.
- Anthem Blue Cross and Blue Shield Indiana Medicaid Provider Manual For Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect.
- Indiana Health Coverage Programs Provider Reference Module: Anesthesia Services.
- Medicare Claims Processing Manual: Chapter 12 – Physicians/Nonphysician Practitioners; Section 50.
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