On July 1, UnitedHealthcare issued a policy update that will no longer include certain physical status considerations in its anesthesia reimbursement calculations.
The policy update specifies that the reimbursement calculations for anesthesia services will no longer include physical status modifiers P3, P4 and P5. These modifiers indicate a patient’s level of disease, with P3 denoting patients with severe systemic disease and P5 denoting a “moribund patient who is not expected to survive without the operation,” according to the American Society of Anesthesiologists.
According to the policy update, UHC will also no longer include additional units for qualifying circumstances indicated by CPT codes 99100, 99116, 99135 and 99140, which correlate with age, hypothermia, hypotension and emergency, respectively. These changes take effect Oct. 1.
In a statement shared with Becker’s, ASA urged UHC to reverse this policy update, saying that the payer “is breaking a meaningful standard in healthcare — that patient care be individualized and care processes and payment appropriately account for the additional risk level of the patient.”
“Insurers disregarding the needs of medically complex patients flies in the face of basic health care, in which a physician assesses a patient’s symptoms and conditions and creates a plan to treat the patient based on that assessment. One size definitely does not fit all,” said ASA President Donald Arnold, MD, in the statement. “It’s shameful that insurers are padding their profits at the expense of payments for those providing important care to complicated patients, as well as patients receiving care in difficult clinical circumstances.”
ASA also noted that with older and more complex patients undergoing surgical procedures in both inpatient and outpatient settings, this policy shift will have a significant impact on the range of care settings and patient access.
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