AdministrativeCommercialApril 1, 2024

HCPCS to revenue code alignment for behavioral health

Effective for all claims received on and after May 1, 2024, Anthem is updating its outpatient facility editing system to align with correct coding guidelines. As a result, claims billed with HCPCS/CPT® codes 0373T, 0362T, 90853, 90887, 96121-96171, 97151-97158, 90785, 90791, 90792, 90832-90847, 90863, H0001-H2035, S0201, S9480, and an inappropriate revenue code(s) will be denied.

For assistance with coding guidelines, please refer to CPT Coding Guidelines or Encoder Pro. If you believe you have received a denial in error, please follow the standard claim payment dispute process outlined in the provider manual. To access, visit anthem.com/provider and select Change State, then select Providers, Guidelines & Manuals. Finally, select Download the Manual under the Provider Manuals ribbon.

In Missouri (excluding 30 counties in the Kansas City area): Anthem Blue Cross and Blue Shield is the trade name of RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

MULTI-BCBS-CM-052241-24

PUBLICATIONS: April 2024 Provider Newsletter