Device-dependent procedures — facility editing update

Effective for all dates of service on and after November 1, 2024, Anthem is updating its outpatient facility editing system to implement a device-dependent procedure edit.

When a device is necessary to perform a specific procedure, both the device and the device-dependent procedure code must be submitted on the same claim and rendered on the same service date. Please visit the Centers for Medicare & Medicaid Services (CMS) Outpatient Code Editor at cms.gov for the most current lists of device-dependent procedure codes and device category codes. These lists may also be found in Appendix 3A and 3B of the Uniform Billing Editor. These lists may be updated to align with CMS changes.

In addition to the CMS-provided device-dependent procedure codes, we are adding CPT^® codes 52441 and 52442 to the device-dependent procedure list for this edit.

If you believe you have received a claim denial in error, please follow the claim dispute process for Anthem.