Reimbursement policy update: Laboratory and Venipuncture Services – Professional and Facility

Beginning with dates of service on or after June 15, 2024, Anthem will update the Related Coding section in the Laboratory and Venipuncture Services – Professional and Facility reimbursement policy.

The following codes will be added to the Facility Section II: Routine Venipuncture and the Collection of Blood Specimen and will not be allowed for separate reimbursement:

• Venipuncture codes (36400, 36405, 36406, 36410, 36415, 36416, 36591 and 36592) when billed by a facility.

Since our last policy review, we have identified that the following language was inadvertently removed from the Modifier 26 comment in the Section II: Modifiers code list:

• When a professional provider has reported modifier 26 to procedure codes designated with NPFSRVF PC/TC indicators 3 or 9, the procedure will not be eligible for reimbursement.

This language will be reinserted, and impacted claims will automatically be reprocessed.

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