Policy Updates Reimbursement PoliciesCommercialNovember 1, 2024

Reimbursement policy reminder: Multiple Surgery — Facility

As a reminder, and as previously communicated through letters we mailed to participating facilities on October 1, 2021, we allow reimbursement for only the primary or highest-valued procedure when multiple or bilateral procedures are performed on the same day or same session and at the same place of treatment when billed by a facility. A single surgical procedure is subject to multiple procedure reduction guidelines when submitted with multiple units.

For specific Multiple Surgery — Facility reimbursement policy details, visit the reimbursement policy page at https://tinyurl.com/ee8v39r9.

With your help, we can continually build towards a future of shared success.

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.

MOBCBS-CM-068273-24-CPN68051

PUBLICATIONS: November 2024 Provider Newsletter