Reimbursement policy update: Laboratory and Venipuncture Services – Professional and Facility

Beginning with dates of service on or after June 1, 2024, Anthem will update the Related Coding section in the Laboratory and Venipuncture Services – Professional and Facility reimbursement policy.

Since our last policy review, we have identified that the following language was inadvertently removed from the Modifier 26 comment in the Section II: Modifiers code list:

• When a professional provider has reported modifier 26 to procedure codes designated with NPFSRVF PC/TC indicators 3 or 9, the procedure will not be eligible for reimbursement.

This language will be reinserted, and impacted claims will automatically be reprocessed.

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