June 6, 2005 - Health Alliance Plan has revised its anesthesia reimbursement policy, effective October 1, 2004.  The changes affect billing and coding for CRNA services and pain management services. FULL TEXT OF THE HAP POLICY

According to the policy, updated May 1, 2005, HAP is implementing a "historical claim auditing function," which will look for the use of the modifiers QX (CRNA services with medical direction by a physician) and AA (Personally performed) for the same patient on the same date of service on all claims. The auditing system will automatically deny the second claim and adjust the provider's account. If a CRNA performs anesthesia services with medical direction, QY or QK must be used to bill for the physician's time.

HAP has also added the modifier QZ (CRNA services not supervised by a physician) as one of the "anesthesia modifiers required for payment."

The modifiers include:

AA - Physician personally performs service
QY - Medical direction of one CRNA or other qualified anesthesia provider
QK - Medical direction of two to four concurrent anesthesia procedures
QX - CRNA services with medical direction by a physician
QZ - CRNA services not supervised by a physician

Pain management providers will be subject to individual provider's contracts.

All changes are retroactive to October 1, 2004.