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Anthem Reimbursement Policy Updates

Anthem has recently update some of its reimbursement policies, these new updates will either apply to professionals or facilities. Below you will find explanations of each new update and which category it falls under. For more detailed information visit the respective sections on Anthems website.

Bundled Services and Supplies and Modifiers 59, XE, XP, XS and XU -Professional

  • Technology used to assist in the performance of a procedure is part of the surgical procedure.

  • Starting May 1, 2018, the policy will be updated to reflect that ultrasonic guidance CPT code 76942 will no longer be eligible for separate reimbursement when its being reported with tendon injections services that are represented by CPT codes 20550.

  • The following modifiers will not override these changes: 59, XE, XP, XS and XU

Evaluation and Management Services and Related Modifiers 25 &27 -Professional

  • Starting on March 1 ,2018 E&M Services (CPT codes 99201-99215) that are eligible for an additional reimbursement when reported by the same provider on the same day as a minor surgery will be reduced by 25%.

  • Minor surgery has a global period of 0-10 days the CPT codes impacted by this are: 10000-69999, this excludes CPT 36415,36416 and 69210.

Facility Drug Testing -Facility

  • Starting May 1,2018 drug testing codes CPT 80320-80377 and 83992 will be considered always bundled codes and won't be eligible for separate reimbursement.

  • CPT codes will be replaced with HCPCS codes G0480-G0483 and G0659

  • This requirement is already included in the Commercial Outpatient Prospective Payment System (COPPS) methodology.

Frequency Editing -Professional

  • Frequency limits will be removed for definitive drug testing HCPCS codes G0482 and G0483.

  • This change was effective as of January 1, 2018.

Global Billing for Professional and Technical Component Reminder -Professional

  • If professional and technical components of a global diagnostic procedure are preformed separately by the same provider/associated provider at the same practice for the same patient on the same date, then those services need to be reported as a global procedure.

  • In reporting the global service Anthem considers the day the professional component rendered as the date of service.

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