Incidental services — facility editing update

Effective for all claims received on or after November 1, 2024, Anthem is updating its outpatient facility editing system to deny claim lines billed with general revenue code 0250 when billed on the same claim with a radiology or diagnostic revenue code. Claims billed with surgical revenue codes 036X or 049X are not subject to this edit.

Per industry standard coding resources, including the Uniform Billing Editor and the National Uniform Billing Committee, care providers should use the more detailed revenue code subcategory when applicable and available rather than revenue codes that end in 0 (General) or 9 (Other). Claims must be coded to the highest level of specificity. As a reminder, unclassified CPT^® code J3490 should only be submitted when there is no specific HCPCS or CPT code for the submitted National Drug Code.

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