Policy Updates Reimbursement PoliciesCommercialFebruary 1, 2024

Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility

Beginning with dates of service on or after April 1, 2024, Anthem will not reimburse for the following when billed on a UB-04:

  • Consultation CPT® codes 99242–99245, 99251–99255
  • Prolonged Services codes 99354–99359, 99415–99417 and G2212

For appropriate billing guidelines of Consultation and Prolonged Services CPT codes, please refer to the corresponding professional Reimbursement Policies:

  • Prolonged Services
  • Consultation Services

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

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.

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PUBLICATIONS: February 2024 Provider Newsletter