Reimbursement Policies

We want to assist physicians, facilities and other providers in accurate claims submissions and to outline the basis for reimbursement if the service is covered by a member's Medi-Cal Managed Care or Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan/MMP) plan.

Keep in mind that determination of coverage under a member's benefit plan does not necessarily ensure reimbursement. Please note:

• These policies may be superseded by state, federal or CMS requirements.
• Providers and facilities are required to use industry standard codes for claim submissions.
• Services should be billed with CPT^® codes, HCPCS codes and/or revenue codes.
• The billed code(s) should be fully supported in the medical record and/or office notes.
• Industry practices are constantly changing and we reserve the right to review and revise policies periodically.

Reimbursement policy disclaimer 

Reimbursement policy definitions