Payers’ implementation of time limits on anesthesia reimbursement has sparked controversy over the last several years, beginning in late 2024 when Anthem Blue Cross Blue Shield proposed a policy that would impose time limits on anesthesia reimbursement in Missouri, New York and Connecticut.
Since then, several states have pushed back on these policies with legislation that would outlaw the time limits as a modifier for anesthesia reimbursements.
Here’s three updates on where state proposals to ban anesthesia time limits stand now:
1. Washington state lawmakers reintroduced a bill that would prohibit insurers from denying coverage or capping reimbursement based on the duration of anesthesia used during a procedure Jan. 29.
House Bill 1812, sponsored by Rep. Alicia Rule, applies to health carriers offering plans to public employees, including Medicaid and those administered by the Washington Health Care Authority. If passed, it would eliminate time caps on anesthesia reimbursement and establish enforcement authority for the Office of the Insurance Commissioner, including monetary penalties, claim repayment and potential license suspension or revocation. Violations would also be published on the agency’s website.
2. Some states have already banned the placement of time limits on anesthesia reimbursements, including Maryland and Illinois.
3. Despite these proposals, Anthem rolled out a policy revision effective Feb. 1, 2025, affecting commercial plans in Connecticut, New York and Missouri. Under the policy, Anthem will calculate allowable anesthesia time based on CMS physician work time values rather than the actual documented anesthesia time. The change applies to anesthesia claims billed under CPT codes 00100 through 01999 and could result in claim denials when procedures exceed preset time thresholds.
