Effective March 12, 2023, Cigna will reduce payment on services reported with modifier QZ by 15%. Modifier QZ identifies services provided by CRNAs without medical direction of a physician. According to Cigna, this was done to align payment with other advanced practice providers (e.g., nurse practitioners). Cigna will only implement this policy change on its commercial lines of business but not on its Medicare Advantage or Medicaid Managed Care lines of business.

At this point, it is hard to determine the impact of this payment cut on business models that anesthesia practices are using. ASA will be monitoring the long-term implications of this policy change on anesthesia practices.

This policy change makes it important for you to have a clearer understanding of what is considered medical direction versus what is considered medical supervision and the billing modifiers that are associated with them. In order to qualify for medically directed service...

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