Material Adverse Change (MAC)

Beginning with dates of service on or after March 1, 2023, Anthem Blue Cross and Blue Shield (Anthem) will update the Bundled Services and Supplies Policy - Professional to include two new CPT codes, 87913 and K1034, as not eligible for separate reimbursement.  Specifically, Section 1 of the policy will be revised as follows to add these 2 new CPT codes:

 

The following codes are not eligible for reimbursement when they are reported with another service or reported as a stand-alone service:

  • 87913 — Infectious agent genotype analysis by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), mutation identification in targeted region(s).
  • K1034 — Provision of COVID-19 test, nonprescription self-administered and self-collected use, FDA approved, authorized, or cleared, one test count.

 

For specific policy details, visit the reimbursement policy page on anthem.com.

 

NVBCBS-CM-012667-22



Featured In:
December 2022 Anthem Provider News - Nevada