Notification Regarding Anthem Fee Schedule Changes
Some highlights of the revised Fee Schedules include:
- Updates to pathology, laboratory and DME codes
- Updates to consult codes 99241 – 99245
Attached with this notice is a sample fee schedule of frequently submitted CPT® codes and their maximum allowable amount effective for dates of service on and after July 1, 2019. This listing is not meant to be representative of all changes that are being made to the Anthem Fee Schedules.
If you have a question about any code you do not see on this list, we encourage you to access the online fee schedule tool via the Availity Web Portal. Go to www.availity.com, log in and select Payer Spaces in the top toolbar, then select Fee Schedule Inquiry under the Applications Link. Please note that the online fee schedules provide allowables for current as well as historical codes and rates. Fee Schedules with an effective date of July 1, 2019 will be available online on or after May 15, 2019.
Anthem will continue to update quarterly the reimbursement tied to the Indiana Medicare Fee Schedules (drugs, durable medical equipment, orthotics and prosthetics for example), in conjunction with Indiana Medicare’s Fee Schedule changes. Some generic drugs, however, may be updated in conjunction with, or off-cycle of, the Indiana quarterly Medicare updates.
Please keep in mind that Anthem reimburses physician extenders such as Nurse Practitioners, Physician Assistants, Certified Registered Nurse Anesthetists, etc. according to the Health Professional Practitioner Fee Schedule. This is a separate Anthem Fee Schedule that is approximately eighty-five percent (85%) of the standard physician Fee Schedule. You may also access specific allowables for this schedule via Availity.
Also, some midlevel mental health provider specialties such as licensed clinical social workers, licensed marriage and family therapists, etc. may be reimbursed at a reduced rate. This rate of reimbursement is approximately eighty percent (80%) of the standard physician Fee Schedule. For details on specific CPT codes, you may access this schedule via Availity.
If you have any questions regarding this notice, please contact your designated Network Representative. Please incorporate this notice into your Anthem provider agreement folder.
Again, thank you for the services you provide for Anthem Members.
*Please note that these Plan Fee Schedule changes do not apply to health care professionals that are located in the Indiana counties of: Washington, Crawford, Harrison, Floyd, Clark, Scott, and Jefferson.
Anthem Indiana Network eUpdate: Notification Regarding Anthem Fee Schedule Changes - May 1, 2019