Anthem Announces Fee Schedule Changes

June 2019 ~

Anthem Blue Cross and Blue Shield (Anthem) recently notified members of the upcoming changes to its Anthem Plan Fee Schedules, scheduled to take place July 1.

The reimbursement policy affects Anthem’s commercial and Medicare Advantage insurance products in states such as Alaska, California, Indiana, Missouri, and Ohio. NOTE: these Plan Fee Schedule changes do not apply to health care professionals that are located in the Indiana counties of: Washington, Crawford, Harrison, Floyd, Clark, Scott, and Jefferson.

The new schedules will apply to Covered Services rendered to Members on or after July 1, for the following Networks: Blue Traditional®, Blue Access®, Blue Preferred® Plans, the Indiana Exchange, HealthSync, Worker’s Compensation, and any other Networks whose fees are based on these statewide fee schedules for reimbursement.

Some highlights of the revised Fee Schedules include:

  • Updates to pathology, laboratory and DME codes
  • Updates to consult codes 99241 – 99245

As an aid, Anthem has provided a sample fee schedule of frequently submitted CPT® codes and their maximum allowable amount effective for dates of service on and after July 1, 2019. The insurer notes that this listing is not meant to be representative of all changes that are being made to the Anthem Fee Schedules.

Anthem will continue to update quarterly the reimbursement tied to the Indiana Medicare Fee Schedules (drugs, durable medical equipment, orthotics and prosthetics for example), in conjunction with Indiana Medicare’s Fee Schedule changes. Some generic drugs, however, may be updated in conjunction with, or off-cycle of, the Indiana quarterly Medicare updates.

The insurer reminds providers to keep in mind that physician extenders such as Nurse Practitioners, Physician Assistants, Certified Registered Nurse Anesthetists, etc. are reimbursed according to the Health Professional Practitioner Fee Schedule. This is a separate Anthem Fee Schedule that is approximately eighty-five percent (85%) of the standard physician Fee Schedule. You may also access specific allowables for this schedule via Availity.

Additionally, Anthem notes that some midlevel mental health provider specialties such as licensed clinical social workers, licensed marriage and family therapists, etc. may be reimbursed at a reduced rate. This rate of reimbursement is approximately eighty percent (80%) of the standard physician Fee Schedule. For details on specific CPT codes, providers may access this schedule via Availity.

In response to the notice, the College of American Pathologists (CAP) has engaged with Anthem to understand the insurer’s reasoning behind the proposed reimbursement reductions for pathology services.

According to CAP, during their discussion with Anthem, representatives stated the decision to make the change is due to the disparity across parts of their network and a need to rebalance rates regardless of setting. CAP states it will continue to engage with Anthem going forward.

 

CPT® is a registered trademark of the American Medical Association.

 

Source(s): Anthem Blue Cross Blue Shield; College of American Pathologists Advocacy Update, May 21, 2019;

 

 

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