Reimbursement policy retraction: updates to professional and facility reimbursement policies

Anthem Blue Cross (Anthem) mailed letters to its participating facilities on September 16, 2022, notifying providers that the following policies would receive updates effective January 1, 2023. However, Anthem has now decided to implement these policies at a later date. There will be no change in billing practices to these policies. We will provide notice when we expect to move forward:

• Bundled Services and Supplies - Professional:
  • Remove codes 99000, 99001, and H0048 from Option 1: Services and Supplies Not Eligible for Separate reimbursement:
    • Note: Moved to Laboratory and Venipuncture Services - Professional and Facility.
• Distinct Procedural Service, Modifiers 59, XE, XP, XS, and XU - Professional:
  • Deny 96365, 96369, 96372, 96373, 96374, and 96379 when reported with 78265, 78830, or 78835.
• Laboratory and Venipuncture - Professional and Facility:
  • Professional policy expanded to include facility providers.
  • Added codes 99000, 99001, and H0048:Note:
    • Moved from Bundled Services and Supplies - Professional.
• Modifier Rules - Professional:
  • Modifier FT is only allowed on critical care codes 99291, 99292, 99468, 99469, 99471, 99472, 99475, and 99476.
  • Added Modifiers 93, FQ to the Modifiers Impacting Adjudication list aligning with the Virtual Visits policy.
  • Added Modifier FS to Informational Modifier list.
• Multiple and Bilateral Surgery Processing - Professional:
  • Added 43497 to base code 43235 Esophagogastroduodenoscopy (EGD) section with the reduction of 100% primary and 25% subsequent.
• Treatment Rooms with Evaluation and Management - Facility:
  • Deny revenue codes 760 and 769 when billed with office Evaluation and Management codes.
• Virtual Visits - Professional and Facility:
  • Added modifiers 93 and FQ.

 

For specific policy details, visit the reimbursement policy page on the Anthem provider website.

CABC-CM-012322-22