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Victory: BCBSMA rolls back restrictive anesthesia policy

We are grateful that BCBSMA heeded our warnings about the potential impact on cancer screening access and patient choice in GI care.

In a significant victory in our collective efforts to safeguard patient choice and healthcare standards, Blue Cross Blue Shield of Massachusetts (BCBSMA) officially postponed its restrictive anesthesia policy until further notice! This change is retroactive to Jan. 1, 2024, so no claims will be rejected for payment. (Read policy update.)

This decision follows intense advocacy efforts by our societies, bringing together a coalition that included the American Society of Anesthesiologists (ASA) and the American College of Surgeons (ACS), with the Massachusetts Gastroenterology Association demonstrating exceptional leadership and the Massachusetts Society of Anesthesiologists (MSA) perseverance throughout the process.

We are grateful that BCBSMA ultimately heeded our warnings about the potential impact on cancer screening access and patient choice in GI care.

Physician leaders representing our societies played a crucial role in meetings with BCBSMA, contributing to this positive outcome. Member engagement, including contacting legislators, media outreach, and participation in the #Noto154 campaign, had a substantial impact.

How to code

BCBSMA informed us that all claims will be paid; however, documentation will still be required for patients presenting with ASA 1 and ASA 2 . Download a list of commonly used diagnosis codes documented with the administration of propofol. We encourage you to still be mindful that BCBSMA will be monitoring the use of these codes for propofol administration. See BCBSMA policy 154 for the complete list of diagnosis codes that support use of MAC. Our societies have requested that BCBSMA provide education to providers on this requirement.

While celebrating this victory, we remain vigilant ā€“ in closely monitoring developments to ensure similar policies are not introduced nationally. Stay tuned for further updates.

Thank you to everyone, including patient advocacy groups involved, for being an essential part of this achievement.

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