New Medicare Rules Clarify AAs Must Be Directed by an Anesthesiologist and May Not Bill Nonmedically Directed as CRNAs Can

For immediate release
June 5, 2013​
For more information
contact Chris Bettin​
The Centers for Medicare & Medicaid Services (CMS) has now clarified and confirmed that anesthesiologist assistants (AAs) may not bill Medicare for nonmedically directed (billing code QZ) anesthesia services as CRNAs are educated and authorized to do.
In a policy transmittal dated May 30, 2013, the agency clarified the distinctions between CRNAs, who may practice autonomously and bill Medicare for their services, and AAs, whose services are covered by Medicare when they are medically directed by an anesthesiologist. Transmittal 2716 amends Chapter 12 of the Medicare Claims Processing Manual governing Medicare Part B coverage of anesthesia care.
Though Medicare Administrative Contractors (MACs) long held that AAs may not bill Medicare QZ, the Palmetto GBA MAC serving the states of California, Hawaii, Nevada, North Carolina, South Carolina, Virginia and West Virginia published an email April 24 stating, “Palmetto GBA has received guidance that the QZ HCPCS modifier is also to be used for an Anesthesiologist Assistant (AA) service performed without medical direction.” Noting that the Palmetto GBA action was inconsistent with Medicare regulations and payment manuals that say an AA is a “person who works under the direction of an anesthesiologist,” AANA addressed the issue directly with Palmetto GBA and the Centers for Medicare & Medicaid Services (CMS).
The action taken by CMS represents an important development in anesthesia services coverage, clarifying what is already known: that CRNA and AA educational preparation and services are not the same, and that the Medicare program recognizes them differently. While Medicare recognizes CRNA services provided autonomously and with anesthesiologist medical direction, in contrast the agency only recognizes AA services under anesthesiologist medical direction. Many public and commercial health plans covering CRNA services follow Medicare’s lead.
The AANA commends the Medicare agency for having an open ear to AANA’s concerns, following and appropriately clarifying the law, and promoting patient access to safe and cost-effective anesthesia care.