Policy Updates Reimbursement PoliciesCommercialJuly 1, 2024

Reimbursement policy update: Incident to Services — Professional

Beginning with dates of service on or after October 1, 2024, Anthem will update the Incident to Service — Professional policy. The intent of the policy is to identify the reimbursement guidelines for incident to services.

This reimbursement policy identifies the following two different types of incidents:

  • Incident to Billing: When Incident to billing services are rendered and billed in accordance with this policy, the incident to services are eligible for reimbursement based on a 15% reduction of the maximum allowance of the applicable supervising provider’s fee schedule.
  • Incident to Services or Supplies: Incident to services or supplies that are essential to the performance of professional service are considered bundled in the primary service and are not allowed for separate reimbursement.

The Related Coding section of the policy includes Modifier SA which must be appended when the supervising physician is billing on behalf of non-physician practitioner (NPP) for non-surgical services.

The policy has been renamed to Incident to Services and Billing — Professional to define incident to services from incident to billing guidelines. 

For specific policy details, visit the reimbursement policy page at Anthem.com/provider.

Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

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PUBLICATIONS: July 2024 Provider Newsletter