ASA Urges Anthem Blue Cross Blue Shield to Maintain Qualifying Circumstance Codes

Last week, ASA submitted a letter to Anthem Blue Cross Blue Shield strongly opposing the insurance provider’s decision to discontinue payment for several anesthesiology qualifying circumstance codes, effective November 1, 2024.

Qualifying circumstance codes, including 99100, 99116, 99135, and 99140, reflect extreme or difficult clinical circumstances for anesthesia care such as life-threatening patient conditions, added risk factors, or emergency environmental conditions. The qualifying circumstances codes capture additional perioperative actions that anesthesiologists must take to ensure patient care appropriately accounts for additional risk to the patient.

ASA’s letter stressed the importance of qualifying circumstance codes on the financial solvency of anesthesia practices and the potential detriment to practices’ quality efforts from the planned policy change. ASA requested a meeting with Anthem Blue Cross Blue Shield to discuss reversing the removal of the codes.

Click here to read ASA’s full letter to Anthem Blue Cross Blue Shield (PDF).

Please contact Helen Olkaba, ASA’s Director of Payment and Practice Management ([email protected]) with any questions.