UPDATED KMAP BULLETIN: Anesthesia Modifier Coverage

Date: 05/14/24

In keeping with current Kansas Medical Assistance Program (KMAP) policy, anesthesia modifiers are required for procedure codes 00100-01999, except for codes 01990 and 01996. Anesthesia services without at least one of the below modifiers will be denied:

The AD modifier is not covered by KMAP.

Effective with dates of service on and after December 1, 2023, when teaching anesthesiology claims are billed, the AA modifier is now required as the first modifier followed by the GC modifier denoting this service has been performed in part by a resident under the direction of a teaching physician. The reimbursement rate will be the same as if the AA modifier was the sole modifier used.

An Anesthesiology Assistant (AA) is a specially trained professional who participates in the care of a surgical patient during general, regional, or conscious sedation anesthesia through the medical direction and under the supervision of an Anesthesiologist. The AA and the supervising anesthesiologist must be employed by the same anesthesia group. The supervising anesthesiologist will bill on behalf of the AA. Currently, an AA practicing in Kansas must work under delegated authority.

Claims utilizing the QK, QX, or QY modifier will be reimbursed at 50%.

For additional information regarding anesthesia billing and reimbursement, please reference the Professional Fee-for-Service Provider Manual.

Note: The effective date of the policy is December 1, 2023. The implementation of State policy by the KanCare Managed Care Organizations (MCOs) may vary from the date noted in the KMAP bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates once the policy is implemented.

For the changes resulting from this provider bulletin, view the updated Professional Fee-for-Service Provider Manual, Section 7010, page 7-2.