AdministrativeCommercialMarch 1, 2025

New coding guidelines: include the anatomic modifier

For claims processed on or after April 1, 2025, our claim editing system will align with the AMA CPT® Manual and HCPCS Level II Manual correct coding guidelines for billing anatomical modifiers 50, RT, and LT.

According to the AMA CPT and HCPCS Level II manuals, the appropriate anatomical modifier must be appended to the appropriate procedure code. These modifiers designate the area or part of the body on which a service is being performed.

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

If you have questions about this notification, contact your network manager or provider relationship management representative.

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-077346-25

PUBLICATIONS: March 2025 Provider Newsletter