Injectable substances with related injection services: Professional

Effective with our Professional Provider Contract Amendment dated September 1, 2019, Anthem Blue Cross and Blue Shield (Anthem) updated our Injectable Substances with Related Injection Services reimbursement policy. There has been much confusion over the claims editing taking place.  When a claim for an injection service is submitted without the applicable Healthcare Common Procedure Coding System (HCPCS Level II) drug or injectable substance code for the injected drug or substance, the code for the injection service will not be eligible for reimbursement.

 

When submitting a claim for an aspiration service, with or without an injection, be sure to include code J3590 (unclassified biologics) with a zero charge to indicate the biologic contents of the syringe after aspiration, or the service will not be eligible for reimbursement

 

Additionally, if the provider did not supply the injectable substance, the HCPCS level II code should be appended with modifier FB to indicate the injectable substance is supplied to the provider at no charge.

 

For additional information, please reach out to your Anthem network manager.

 

578-0820-PN-VA