It all started with Cigna back in May of 2021. They were the first managed care carrier to implement prorated anesthesia time units, a subtle change that cost groups 0.5 units/case. Since that time, carriers have introduced additional policy changes, resulting in the erosion of negotiated contracted unit rates. The purpose of this article is to summarize these insurance changes, their impact on your practice’s bottom line, and suggested, proactive steps to combat the issue.
Timeline of Payor Policy Changes
May, 2021 (Cigna)
Switched to Prorated (fractionalized) time units. Old policy rounded up to next whole unit; new policy uses one decimal point to represent completed portions of a 15-minute time unit. Example: a 37-minute GI case was formerly credited with 3 whole time units. Under the new policy, the case is now valued at 2.5 time units. On average, this change cost anesthesia practices the value of 0.5 Cigna units.
March, 2023 (Cigna)
Reduced payment on non-medically-directed (-QZ modifier) cases from 100% to 85%. *Anthem BCBS had already implemented the same policy. Revenue impact to practices varied, based on clinical delivery model.
July, 2024 (Aetna)
New policy introduced which eliminated payments for ASA Physical Status Modifiers 3-5 (one -three units, respectively). Impacted hospital-based groups more than ASC service locations.
November, 2024 (Anthem BCBS)
New anesthesia policy introduced to cap anesthesia time based on average surgical time, in CT, MO & NY. Policy retracted a month later, after successful ASA lobbying efforts.
October, 2025 (United Healthcare)
New anesthesia policy implemented which reduces payment for non-medically directed cases (-QZ modifier) from 100% to 85%. Other policy changes included the elimination of payment for ASA Physical Status Modifiers (ASA 3 – ASA 5), as well as Qualifying circumstances (i.e., Emergency). *Practices in Arkansas, California, Colorado, Hawaii, Massachusetts, New Hampshire and Wyoming are excluded from the -QZ 15% reduction in payment.
October, 2025 (BCBS TN)
New policy implemented which eliminates payments for Physical Status Modifiers and reduces payment on -QZ claims by 15% (Commercial and BlueCare plans).
Next Moves to Neutralize Impact of Policy Changes
It’s crucial that your biller perform an analysis of what these payor policy changes mean to your group’s bottom line. Once quantified, it’s appropriate to reach out to your payor contract representative and ask for a meeting. Showing them your calculations, ask for a unit increase to your contracted rate to offset the material financial impact of these policies. For MSN Anesthesia Clients, this analysis has already been performed on your behalf. If you are not currently an MSN Anesthesia Billing Client and would like our assistance in this regard, please don’t hesitate to ask. We are passionate about the specialty of Anesthesiology and want each clinician to retain 100% of their revenue for clinical services rendered.
