Updates to edits associated with implants

Effective for all claims received on or after July 1, 2022, in accordance with Anthem Blue Cross and Blue Shield (Anthem) reimbursement policy titled Implant – Facility, we will implement additional steps to review claims submitted by facilities that inappropriately include HCPCS supply codes (e.g., HCPCS codes for catheters, needles, guidewires) billed with implant revenue codes (e.g., 0278).

 

Anthem considers implants to be medical devices that remain in the member’s body upon discharge from the procedure and therefore, supplies are not considered implants. Claims for supplies should be submitted with the appropriate revenue code(s). Claim lines billed inappropriately will be denied. Providers can resubmit claims for supplies using the appropriate revenue code(s).

 

If you have questions about this policy, contact your Contract Manager or Provider Experience representative.

 

2746-0622-PN-IN.WI