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.

Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield of Wisconsin (BCBSWI), Compcare Health Services Insurance Corporation (Compcare), and Wisconsin Collaborative Insurance Company (WCIC). BCBSWI underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC; Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

MULTI-BCBS-CM-047188-23

PUBLICATIONS: February 2024 Provider Newsletter