Cigna will lower its reimbursement for claims submitted with the QZ modifier, which indicated a non-medically directed CRNA service. The payer cited evidence-based medicine, society recommendations, CMA guidance and industry standards as supporting the shift, according to Mr. Mira’s March 7 post.
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.
For groups that employ CRNAs, this means less revenue. Mr. Mira suggested that anesthesia practices with a collaborative mode, where CRNA cases are non-medically directed, move to a medical direction model.
“This appears to be the first time we’ve seen a major national health insurance company impose such a position,” Mr. Mira wrote. “Serious policy divergences from a major player in the market such as Cigna may have the effect of causing other significant health plans to be more willing to consider a similar policy change.”
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