Cigna lowering reimbursement for some procedures 'seems to be a bit arbitrary,' anesthesia leader says

Cigna has lowered reimbursements for non-medically directed procedures performed by certified registered nurse anesthetists by 15 percent, Tony Mira, CEO of Anesthesia Business Consultants, wrote in a March blog post

According to the post, Cigna is cutting the procedures based on evidence-based medicine, professional society recommendations, CMS guidance, industry standards and their other policies. 

"It is uncertain how the payer determined to change its long-standing payment practices based on the above sources," he wrote. "The other sources listed are not particularly determinative as there is no uniformity among the studies and the professional societies in this regard."

Cigna will lower its reimbursement for claims submitted with the QZ modifier, which indicates a non-medically directed CRNA service. The policy change does not apply to the QX modifier, which means the CRNA is medically directed. For QX procedures, CRNAs will still receive 50 percent of the allowable, with the directing anesthesiologist receiving the other 50 percent.  

The move is a divergence from the industry standard, according to Mr. Mira

"On the whole, Cigna's decision seems to be a bit arbitrary and clearly runs counter to the way QZ services are reimbursed across the payer spectrum," Mr. Mira added. "This appears to be the first time we've seen a major national health insurance company impose such a position."

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