Anthem BCBS Professional Bundled Services and Supplies Update

December 2018 ~

Anthem has released an update regarding the coding of bundled services for continuous intraoperative neurophysiology monitoring, from outside the operating room.

Beginning with dates of service on or after March 1, 2019, Anthem will apply its ‘always bundled’ edit to HCPCS code G0453 (continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure)).

According to Section 1 of the policy, service and supplies not eligible for separate reimbursement. In most cases, services rendered without direct (face-to-face) patient contact are considered to be an integral component of the overall medical management service and are not eligible for separate reimbursement. In addition, modifier 59, XE, XP, XS & XU will not override the denial for the bundled services and/or supplies listed below.

These bundled services and supplies may include, but are not limited to:

1. add-on code to identify services rendered by a hospitalist provider
2. administrative services requiring physician documentation (e.g., recertification, release forms, physical/camp/school/daycare forms, etc.)

The list below, provided by Anthe, is an informational tool created to help identify some examples of the services and supplies described above. The exclusion of a specific code does not indicate eligibility for reimbursement under all circumstances.

Source(s): Anthem Network Update;