Material Adverse Change (MAC)

 

Reimbursement changes to COVID-19 laboratory services codes for Commercial and Medicare Advantage programs from Anthem Blue Cross and Blue Shield (Anthem) in Missouri.

 

Beginning with dates of service on or after January 12, 2023, or the end of the public health emergency (PHE), whichever is the latter, reimbursement for COVID-19 laboratory services codes will be reduced for providers contracted as independent laboratory (ancillary) providers and participating in an Anthem Independent Laboratory Provider network.

 

New COVID-19 laboratory service codes were implemented and reimbursed at rates to meet the needs of providers during the PHE. Reimbursement will be revised to Anthem’s standard reimbursement methodology for independent laboratory providers for the following codes:

 

U0001

86328

87426

87811

0226U

U0002

86408

87428

0202U

0240U

U0003

86409

87635

0223U

0241U

U0004

86413

87636

0224U

 

U0005

86769

87637

0225U

 

 

The revised standard fee schedule for the COVID-19 laboratory services codes outlined above can be viewed on www.availity.com* beginning January 12, 2023.

 

If you have any questions regarding this notice, please contact your designated Ancillary Provider Network manager. Please incorporate this notice into your Anthem provider agreement folder.


* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield.
MOBCBS-CRCM-013047-22-CPN12350



Featured In:
December 2022 Anthem Provider News - Missouri