Reimbursement policy update: Clinic Charges (Facility)

A new facility reimbursement policy titled “Clinic Charges – Facility” will be implemented beginning with dates of service on or after April 1, 2021.  This policy indicates that a facility will not be reimbursed for clinic services rendered to a covered individual by a professional provider at any clinic that is owned, operated or controlled by a facility or health system when billed on a UB-04.  Services that are rendered in an office, professional building, medical office building, free standing clinic or other associated spaces must be billed on a CMS-1500.

For more information about this policy, visit the Reimbursement page at anthem.com.

944-0121-PN-GA