Reimbursement Policy Update: Multiple and Bilateral Surgery, Professional and Facility Reimbursement

Category: Medicaid

 

(Policy 06-010, effective 03/01/20)

 

Anthem Blue Cross and Blue Shield (Anthem) allows reimbursement to professional providers and facilities for multiple and bilateral surgery.

 

Effective March 1, 2020, the following updates have been made to the policy:

• Anthem added language to the policy to note that when billed by ambulatory surgical centers (ASCs), Modifier 50 is not recognized and additional reimbursement is not provided for bilateral procedures.
• Anthem reimburses ASCs 100% of the fee schedule or contracted/negotiated rate based on the primary procedure performed.

 

Please visit https://mediproviders.anthem.com/wi to view the Multiple and Bilateral Surgery reimbursement policy for additional information regarding percentages and reimbursement criteria.