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November 17, 2015

BCBSAL Announces Updated Changes for MAC Reimbursements

November 17, 2015

Surgical Procedures and Monitored Anesthesia Care

Blue Cross Blue Shield of Alabama has released updated changes for Monitored Anesthesia Care (MAC) reimbursements released to GI cases.  The new effective date is December 28th 2015.  As BCBS has released limited information we anticipate many changes before the implementation date.

What we know as of today, BCBS will reduce reimbursement to the GI doctors by 5%.  BCBS will reduce payment to anesthesia by approximately 45% as well as completely change the methodology of payment.  Changing from the base+time model to a flat fee for GI procedures is unprecedented in Alabama.

The new reimbursement for MAC anesthesia in GI cases will be:

00740 = $248

00810 = $275

BCBSAL will split the payment 65/35 if medically directed by an anesthesiologist.  If performed by a CRNA only, the reimbursement will be 70%.

If both procedures are performed during the same sedation, BCBSAL will only pay for one procedure.

As previously mentioned, this is a fundamental change to the reimbursement model for anesthesia that will greatly impact all anesthesia providers throughout the state of Alabama.

To learn more about these changes and the potential impact to your reimbursements, please contact Medical Business Management.

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