Anthem prolonged services policy The determination that a service, procedure, item, etc. Jul 1, 2023 · Beginning with dates of service on or after October 1, 2023, Anthem Blue Cross and Blue Shield and our subsidiary company, HMO Colorado (Anthem), will update the Prolonged Services- Professional reimbursement policy as follows: These policies serve as a guide to assist you in accurate claims submissions and to outline the basis for reimbursement if the service is covered by a member’s Anthem Blue Cross and Blue Shield benefit plan. These reimbursement policies serve as a guide to assist you in accurate claims submissions and to outline the basis for reimbursement if the service is covered by an Anthem Blue Cross and Blue Shield (Anthem) member’s benefit plan. Oct 17, 2025 · These reimbursement policies may be superseded by mandates in provider, state, federal, or Centers for Medicare & Medicaid Services (CMS) contracts and/or requirements. is covered under a member's benefit plan is not a determination that you will be reimbursed. Jun 30, 2023 · Anthem Provider News announces a reimbursement policy update for prolonged services in Missouri. Update the Related Coding Section to: Remove CPT ® codes 99354 – 99357 to align with the 2023 AMA CPT code changes Mar 31, 2023 · Effective April 1, 2023, Anthem Blue Cross and Blue Shield will update the documentation and reporting guidelines for Evaluation and Management Services — Professional reimbursement policy to align with CMS guidance for documenting evaluation and management (E/M) services and determining E/M service level. Jun 30, 2023 · Reimbursement policy update: Prolonged Services - Professional Beginning with dates of service on or after October 1, 2023, Anthem Blue Cross and Blue Shield will update the Prolonged Services- Professional reimbursement policy as follows: Remove language requiring providers to report start and stop times for reimbursement eligibility. These reimbursement policies serve as a guide to assist you in accurate claims submissions and to outline the basis for reimbursement if the service is covered by an Anthem member’s benefit plan. These codes will be payable based on our existing Prolonged Services policy, which will be updated to reflect the Dec 26, 2024 · Coverage Guidelines and Clinical Guidelines update, April 1, 2025 Special note The services mentioned in the Coverage Guidelines in this document will require authorization for all our products offered by Anthem Blue Cross and Blue Shield, with the exception of the Anthem HealthKeepers Plus program. Sep 1, 2023 · In the July 2023 edition of Provider News, reimbursement policy page we announced multiple updates to the Prolonged Services – Professional reimbursement policy Ohio effective October 1, 2023. These codes will be payable based on our existing Prolonged Services policy, which will be updated to reflect the new code along with the modifications to existing prolonged service codes CPT codes 99354 and 99355. These policies may be superseded by mandates in provider, State, Federal or Centers for Medicare and Medicaid Services (CMS) contracts and/or requirements. Services must Feb 1, 2024 · 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. Feb 1, 2024 · 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. Anthem reserves the right to review and revise these policies periodically when Jun 30, 2023 · Beginning with dates of service on or after October 1, 2023, Anthem Blue Cross and Blue Shield will update the Prolonged Services- Professional reimbursement policy as follows: Remove language requiring providers to report start and stop times for reimbursement eligibility. Jun 30, 2023 · Anthem Blue Cross and Blue Shield announces updates to the Prolonged Services-Professional reimbursement policy for New York healthcare providers. Oct 1, 2025 · Beginning with dates of service on or after November 1, 2025, Anthem will update the Prolonged Services — Professional reimbursement policy as follows: CPT ® code G2212 will be removed from the Related Coding Section and added to the Bundled Services and Supplies — Professional reimbursement policy as non‑reimbursable. Jan 1, 2021 · CPT codes 99202 through 99215 (new/established E/M) definitions have changed. Jun 30, 2023 · Beginning with dates of service on or after October 1, 2023, Anthem Blue Cross and Blue Shield will update the Prolonged Services- Professional reimbursement policy as follows: Remove language requiring providers to report start and stop times for reimbursement eligibility. Jun 30, 2023 · Beginning with dates of service on or after October 1, 2023, Anthem Blue Cross and Blue Shield will update the Prolonged Services- Professional reimbursement policy as follows: Remove language requiring providers to report start and stop times for reimbursement eligibility. Mar 31, 2023 · Effective April 1, 2023, Anthem Blue Cross and Blue Shield will update the documentation and reporting guidelines for Evaluation and Management Services — Professional reimbursement policy to align with CMS guidance for documenting evaluation and management (E/M) services and determining E/M service level. Keep in mind that a determination of coverage does not necessarily ensure reimbursement. If there is a delay, we reserve the right to recoup and/or recover claims payment to the effective date, in accordance with the policy. To clarify, the update to “remove language requiring providers to report start and stop times for reimbursement eligibility” was effective as of May 19, 2023. Find information for assessing coverage options, guidelines for clinical utilization management, practice policies and support for delivering benefits to our members. These policies may be superseded by provider or state contract language, or state, federal requirements or mandates. UnitedHealthcare reimbursement policies may use Current Procedural Terminology (CPT®*), Centers for Medicare and Medicaid Services (CMS) or other coding guidelines. These codes will be payable based on our existing Prolonged Services policy, which will be updated to reflect the Feb 1, 2024 · 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. Policy The health plan allows reimbursement for prolonged services when billed as described in this policy, unless provider, state, or federal contracts and/or mandates indicate otherwise. We reserve the right to review and This reimbursement policy is intended to ensure that you are reimbursed based on the code or codes that correctly describe the health care services provided. CPT codes 99202 through 99215 (new/established E/M) definitions have changed. Update the Related Coding Section to: Remove CPT ® codes 99354 – 99357 to align with the 2023 AMA CPT code changes Feb 7, 2017 · These reimbursement policies may be superseded by mandates in provider, state, federal, or Centers for Medicare & Medicaid Services (CMS) contracts and/or requirements. We reserve the right to review and Feb 1, 2024 · 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. These policies may be superseded by state, federal or Centers for Medicare and Medicaid Services (CMS) requirements. Sep 1, 2023 · In the July 2023 edition of Provider News, Empire BlueCross BlueShield announced multiple updates to the Prolonged Services – Professional reimbursement policy effective October 1, 2023. Jun 30, 2023 · Anthem Blue Cross and Blue Shield updates the Prolonged Services-Professional reimbursement policy, removing start and stop time reporting requirements for eligibility. To clarify, the update to “remove language requiring providers to report start and stop times for reimbursement eligibility” was effective as of May 19 Jan 1, 2021 · CPT code 99417 (prolonged services) and HCPCS Code G2212 (prolonged services) will be recognized as billable codes. Policy Anthem does not allow reimbursement for standby or hospital-mandated on-call services unless provider, state, or federal contracts and/or mandates indicate otherwise. We strive to minimize delays in policy implementation. Update the Related Coding Section to: Remove CPT ® codes 99354 – 99357 to align with the 2023 AMA CPT code changes Jun 30, 2023 · Beginning with dates of service on or after October 1, 2023, Anthem Blue Cross and Blue Shield will update the Prolonged Services- Professional reimbursement policy as follows: Remove language requiring providers to report start and stop times for reimbursement eligibility. The Anthem Blue Cross and Blue Shield (Anthem) policies outline the basis for reimbursement of covered services under a member’s Anthem plan. Nonreimbursable: Anthem’s reimbursement policies are developed based on nationally accepted industry standards and coding principles. com. Selection of these E/M codes can now be based on either Medical Decision Making or Time. Update the Related Coding Section to: Remove CPT ® codes 99354 – 99357 to align with the 2023 AMA CPT code changes Sep 1, 2023 · In the July 2023 edition of Provider News, reimbursement policy page we announced multiple updates to the Prolonged Services – Professional reimbursement policy Colorado effective October 1, 2023. Learn about the latest changes and their implications. In Virginia: Anthem Health Plans of Virginia, Inc. We reserve the right to review and Jan 1, 2021 · CPT code 99417 (prolonged services) and HCPCS Code G2212 (prolonged services) will be recognized as billable codes. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. This update includes CMS’ adoption of the American Medical Association (AMA) Current Oct 1, 2022 · In Ohio: Community Insurance Company. The health plan allows reimbursement for prolonged services when billed as described in this policy, unless provider, state, or federal contracts and/or mandates indicate otherwise. Sep 1, 2023 · In the July 2023 edition of Provider News, reimbursement policy page we announced multiple updates to the Prolonged Services – Professional reimbursement policy Indiana effective October 1, 2023. These reimbursement policies may be superseded by mandates in provider, state, federal, or Centers for Medicare & Medicaid Services (CMS) contracts and/or requirements. Reimbursement is allowed for the specific service or procedure rendered by the provider following the standby period. Jun 30, 2023 · Reimbursement policy update: Prolonged Services — Professional Beginning with dates of service on or after October 1, 2023, Anthem Blue Cross and Blue Shield will update the Prolonged Services- Professional reimbursement policy as follows: Remove language requiring providers to report start and stop times for reimbursement eligibility. Disclaimer These reimbursement policies serve as a guide to assist you in accurate claims submissions and to outline the basis for reimbursement if the service is covered by an Anthem Blue Cross and Blue Shield (Anthem) member’s benefit plan. This update includes CMS’ adoption of the American Medical Association (AMA) Current . Sep 1, 2023 · In the July 2023 edition of Provider News, reimbursement policy page we announced multiple updates to the Prolonged Services – Professional reimbursement policy Kentucky effective October 1, 2023. CPT code 99417 (prolonged services) and HCPCS Code G2212 (prolonged services) will be recognized as billable codes. 88 ejbtejznnv 8xw1c4h k4oljwmz zp5ct x92ios qz ocgyg u8h7 rzvqct