ASA Continues to Urge Anthem Blue Cross Blue Shield to Maintain Qualifying Circumstance Codes

ASA met with Anthem Blue Cross Blue Shield/Elevance officials earlier this week to express concern with their 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 circumstances and clinical conditions anesthesiologists manage but are not captured by anesthesiology CPT codes. Such codes ensure patient care appropriately accounts for additional risk to the patient.

During the meeting, ASA emphasized that there is no duplication in the value of these codes and described the importance of qualifying circumstance codes on the financial solvency of anesthesia practices as well as the potential detriment to practices’ quality efforts from the planned policy change. 

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

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