Anthem prolonged services policy. 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. 4 days ago · The document outlines services requiring prior authorization under Ohio Medicaid and MyCare, potentially affecting members by mandating preapproval for certain healthcare services to ensure coverage. These services and/or supplies may be reported with a primary service or as a stand-alone service. 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. Find information for assessing coverage options, guidelines for clinical utilization management, practice policies and support for delivering benefits to our members. 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. 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. 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. Update the Related Coding Section to: Remove CPT ® codes 99354 – 99357 to align with the 2023 AMA CPT code changes Sep 1, 2023 · Beginning January 1, 2024, Empire became Anthem. 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. com. We strive to minimize delays in policy implementation. This article, published under the former brand, now applies to Anthem. Policy Anthem considers certain services and supplies to be ineligible for separate reimbursement when reported by a professional provider, unless provider, state, or federal contracts and/or requirements indicate otherwise. 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. These policies may be superseded by provider or state contract language, or state, federal requirements or mandates. For the most up-to-date and detailed listing of services that require authorization, visit our provider website. 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. 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. Jun 30, 2023 · Anthem Blue Cross and Blue Shield announces updates to the Prolonged Services-Professional reimbursement policy for New York healthcare providers. Update the Related Coding Section to: Remove CPT ® codes 99354 – 99357 to align with the 2023 AMA CPT code changes 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. Jan 1, 2021 · CPT code 99417 (prolonged services) and HCPCS Code G2212 (prolonged services) will be recognized as billable codes. 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. Update the Related Coding Section to:. 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. 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. rcp hmi ibk nty gbb seg luv iye lhr ljc ouy cbi tgu bdo dbi