At AmeriHealth, we are stewards of our members’ health care dollars and are constantly reviewing our policies – using industry benchmarks and best practice standards – to make sure they align with members’ needs and are cost-effective.

As a result of policy reviews, AmeriHealth has decided that effective January 1, 2019, we will discontinue additional reimbursement for the anesthesia physical status modifiers P3, P4, and P5 on claims submitted with American Society of Anesthesiologists procedure codes for AmeriHealth members.

Our decision to make this change was based on the position of the Centers for Medicare & Medicaid Services, which does not recognize or issue additional reimbursement for anesthesia physical status modifiers P3, P4, and P5.

Policy update

AmeriHealth is updating Claim Payment Policy #00.01.14q: Reporting and Documentation Requirements for Anesthesia Services, which outlines its reimbursement position on anesthesia physical status modifiers. This updated policy was posted as a Notification on October 1, 2018, and will go into effect January 1, 2019.

To view the Notification for this policy, visit our Medical Policy Portal and select Accept and Go to Medical Policy Online. Then select Active Notifications.

Learn more

For more information on this change in our reimbursement position, please view our Reimbursement position for anesthesia physical status modifiers: Frequently Asked Questions (FAQ) document, which can also be found in the Frequently Asked Questions archive on AmeriHealth NaviNet^? Plan Central. Note: The FAQ will be updated as more information becomes available.

If you still have questions after reviewing the FAQ, email us at anesthesiamodifiers@amerihealth.com. Be sure to include your name, contact number, and provider ID number in your email.

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