New reimbursement policy: Modifier Usage — Facility

Beginning with dates of service on or after May 1, 2024, Anthem will implement a new reimbursement policy titled Modifier Usage — Facility based on the code-set combinations submitted with the correct modifiers. This reimbursement policy identifies the following three different types of facility modifiers:

• Reimbursement modifiers affect payment and denote circumstances when an increase or reduction is appropriate for the service provided. 
• Informational modifiers impacting reimbursement determine if the service provided will be reimbursed or denied. 
• Informational modifiers not impacting reimbursement are used for documentation purposes. 

The Related Coding section of the policy includes a Facility Modifier code list which identifies the modifier, the modifier description, and any related reimbursement policies. The Facility Modifier code list also includes six modifiers that do not have associated reimbursement policies. These modifiers indicate a reduced service or different equipment was used for the service. These modifiers will result in a reduction when billed on a facility claim. 

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