New reimbursement policy: Multiple and Bilateral Surgery Processing (facility) (MAC)

Material adverse change (MAC)

 

Beginning with dates of service on or after June 1, 2022, Anthem will implement a new facility reimbursement policy titled, Multiple and Bilateral Surgery Processing (facility). 

 

Anthem allows reimbursement for only the primary, or highest valued, procedure when multiple or bilateral procedures are performed on the same day or same session, and at the same place of treatment when billed by a facility. A single surgical procedure is subject to multiple procedure reduction guidelines when submitted with multiple units.

 

For more information about these policies, visit the Reimbursement Policy page on our anthem.com/provider website.

 

490-0322-PN-GA