Reimbursement Policy update: Prolonged Services — Professional (MAC)

Material adverse change (MAC)

Beginning with dates of service on or after October 1, 2023, Anthem Blue Cross and Blue Shield will update the Prolonged Services- Professional reimbursement policy as follows:

• Remove language requiring providers to report start and stop times for reimbursement eligibility.
•  Update the Related Coding Section to:  
  • Remove CPT^® codes 99354 – 99357 to align with the 2023 AMA CPT code changes. 
  • Add CPT code 99418 to align with the 2023 AMA CPT code changes.
  • Remove CPT code G2212 and add to the Bundled Services and Supplies - Professional reimbursement policy as not reimbursable.
    • Remove the ICD-10-CM code list.

If you believe a claim reimbursement decision should be reviewed, please follow the normal claims dispute process outlined in the Provider Manual. 

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