CommercialDecember 3, 2024
Outpatient system updates for 2025
As a reminder, we will update our claim editing software for outpatient facility services throughout 2025, with many updates occurring quarterly. These updates include, but are not limited to:
- The addition of new and revised codes (for example, CPT®, HCPCS, ICD‑10, modifiers, and revenue codes) and associated edits
- Updates related to the appropriate use of various code combinations, including but not limited to CPT/HCPCS code to revenue code, type of bill to procedure code, type of bill to CPT/HCPCS code, and CPT/HCPCS code to modifier
- Updates to National Correct Coding Initiative edits (NCCI) and facility outpatient hospital services medically unlikely edits (MUEs)
- Updates to reflect coding requirements as designated by industry‑standard sources such as the National Uniform Billing Committee (NUBC) and the CMS
- Updates to code edits associated with reimbursement policies, including bundled services and supplies, diagnostic radiopharmaceuticals, and contrast materials
Commercial services provided by Anthem Blue Cross and Blue Shield, trade name of Anthem HealthChoice HMO, Inc. and Anthem HealthChoice Assurance, Inc., or Anthem Blue Cross and Blue Shield HP, trade name of Anthem HP, LLC.
Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
MULTI-BCBS-CM-072767-24-CPN72654
To view this article online:
Visit https://providernews.anthem.com/new-york/articles/outpatient-system-updates-for-2025-23232
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