Reimbursement is based on a percentage of the fee schedule or contracted/negotiated rate for the surgical procedure. Currently:

  • Modifier 54 (surgical care only) is reimbursed at 80%.
  • Modifier 55 (postoperative management only) is reimbursed 20%.
  • Anthem Blue Cross does not allow separate reimbursement for Modifier 56.

 

Effective March 1, 2021, Anthem Blue Cross will continue to reimburse on a percentage of the fee schedule or contracted negotiated rates for the surgical procedure. However, the following rates have been amended:

  • Modifier 55 (postoperative management only) will be reimbursed at 30%.

 

For additional information, review the Split-Care Surgical Modifiers reimbursement policy at https://mediproviders.anthem.com/ca.

 



Featured In:
December 2020 Anthem Blue Cross Provider News - California