Reimbursement policy updates for facilities

In the January 2024 publication of Provider News, we announced a reminder to the October 1, 2023 mailing for the following policies effective with dates of service on or after January 1, 2024:

• Treatment Rooms — Facility
• Place of Service — Facility

Effective with dates of service on or after September 22, 2024, Anthem will implement the following updates: 

Reimbursement policy update: Treatment Rooms — Facility 

Anthem will expand the current policy to include two additional revenue codes (760 and 769) and add HCPCS code G0463 to the Related Coding section. The code description for G0463 is hospital outpatient clinic visits or assessment and management of a patient. G0463 is not eligible for reimbursement when reported with revenue code 760, 761, or 769.

Reimbursement policy update: Place of Service — Facility

Anthem will update the policy language to indicate the following:

• Professional services billed under revenue codes 960 to 989 are non-reimbursable when submitted on a UB-04.

• Preventive counseling CPT^® codes 99401 to 99404, 99411, and 99412 are non-reimbursable when billed in an outpatient setting. 

 As a reminder, evaluation and management (E/M) services and professional services (excluding E/M services rendered in the emergency room and billed with ER revenue codes) must be billed on a CMS-1500 form. 

To view the reimbursement policies, log in to Availity.com, select Anthem Blue Cross in the Payer Spaces, then select Information Center. Select Administrative Support, then select the Reimbursement Policies — Facility and Professional link. Reimbursement policies are listed in alphabetical order. 

If you are not registered for Availity, go to Availity.com and go to the upper right-hand corner to complete the registration process.

To view the reimbursement policies, log in to anthem.com/ca. Go to For Providers > Policies, Guidelines & Manuals. Scroll down to Reimbursement Policies and select Access Policies. Policies are listed in alphabetical order.