New reimbursement policy: Diagnostic Radiopharmaceuticals and Contrast Materials — Professional and Facility

Beginning with dates of service on or after October 1, 2024, Anthem will implement a new reimbursement policy titled Diagnostic Radiopharmaceuticals and Contrast Materials —Professional and Facility.

Under this policy, when radiopharmaceuticals and contrast materials are billed by the facility, such services are not reimbursed as they are considered included in the facility fee. In addition, the following statement was removed from the Place of Service — Professional reimbursement policy and added to this policy:

The health plan does not allow separate reimbursement for diagnostic radiopharmaceutical and contrast materials by professional providers when reported in a facility place of service.

The Related Coding section contains specific codes with guidelines for both professional and facility providers.

For specific policy details, visit the reimbursement policy page at anthem.com/provider.

Through our efforts, we are committed to reducing administrative burden and ensuring timely payments because we value you, our care provider partners.