Policy Updates Reimbursement PoliciesMedicare AdvantageAugust 1, 2024

Reimbursement policy update: Modifier 78

(Policy G-06016, effective 07/01/2024)

Past system limitations prevented us from reimbursing Modifier 78 in complete alignment with Centers for Medicare & Medicaid Services (CMS). New system updates will now allow Anthem to closer align with the CMS Medicare Physician Fee Schedule Data Base (MPFSDB).

For claims processed on and after 07/01/2024, you may see a slight adjustment in reimbursement which will reflect this configuration update.

For additional information, please review the Modifier 78 reimbursement policy at anthem.com/ca/provider/medicare-advantage.

Anthem BC Health Insurance Company is the trade name of Anthem Insurance Companies, Inc. Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross, Anthem Blue Cross Life and Health Insurance Company, and Anthem BC Health Insurance Company are independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

CABC-CR-048993-23-CPN45239

PUBLICATIONS: August 2024 Provider Newsletter