*Material Adverse Change (MAC)

Beginning with dates of service on or after October 1, 2022, Anthem Blue Cross and Blue Shield will implement a new facility reimbursement policy titled Place of Service – Facility


The policy outlines professional services that can be rendered in an office, professional building, medical office building, clinic or a space owned by a hospital or an institutional provider, other than the primary structure on the campus of the hospital or institutional provider or rented by a professional from the hospital or an institutional provider.


Evaluation & Management (E/M) services and other professional services must be billed on a CMS-1500 claim form and are not reimbursable if they are billed on a UB-04 claim form (excluding E/M services rendered in an emergency room and billed with ER Revenue codes). In addition, professional services billed under revenue codes 960-983 and preventive counseling CPT codes 99406-99409, 99411 and 99412 when billed in an outpatient setting are not reimbursable when submitted on a UB-04.


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




Featured In:
July 2022 Anthem Provider News - Wisconsin