*Change to Prior Authorization Requirements


Beginning with dates of service on or after March 1, 2022, Anthem Blue Cross and Blue Shield (Anthem)’s Co-Surgeon/Team Surgeon Services commercial reimbursement policy will be retired and replaced with the following reimbursement policies:

 

  • Modifier 62: Co-Surgeon Services – professional: Under this reimbursement policy, Anthem allows reimbursement of procedures eligible for co-surgeons when billed with modifier 62. Anthem follows the Centers for Medicare & Medicaid Services (CMS) Medicare Physician Fee Schedule (MPFS) Co-Surgery payment indicators and will allow services requiring a co-surgeon billed with CMS MPFS payment indicator ‘2’ (always) and will deny services billed with indicator ‘0’ (never), ‘1’ (sometimes) and ‘9’ (not applicable). Reimbursement for each surgeon is based on 63 percent of the applicable fee schedule or contracted/negotiated rate.

 

  • Modifier 66: Surgical Teams – professional: Under this reimbursement policy, Anthem allows the of procedures eligible for surgical teams when billed with modifier 66. Anthem follows the CMS MPFS Team Surgery payment indicators and will allow services requiring team surgery billed with CMS MPFS payment indicator ‘1’ (sometimes) and ‘2’ (always), and will deny services billed with the indicator ‘0’ (never) and ‘9’ (not applicable).

 

For more information about these new policies, visit the Reimbursement Policy page at anthem.com provider website.

 

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Featured In:
December 2021 Anthem Provider News - Indiana