Reimbursement Policies

Our goal is to assist physicians, facilities and other health care providers with accurate claim submissions. The Anthem Blue Cross and Blue Shield (Anthem) policies outline the basis for reimbursement of covered services under a member’s Anthem plan. Keep in mind that a determination of coverage does not necessarily ensure reimbursement.

These policies may be superseded by state, federal or Centers for Medicare and Medicaid Services (CMS) requirements. Providers and facilities are required to use industry standard codes for claim submissions. Services should be billed with Current Procedure Terminology (CPT^®) codes, Healthcare Common Procedure Coding System (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.