anthem procedure code lookup

CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. Current Procedural Terminology, more commonly known as CPT, refers to a medical code set created and maintained by the American Medical Association and used by physicians, allied health professionals, nonphysician practitioners, hospitals, outpatient facilities, and laboratories to represent the services and procedures they perform. Be sure name and NPI entered for ordering provider belongs to a physician or non-physician practitioner. Find answers to all your questions with an Anthem representative in real time. Find drug lists, pharmacy program information, and provider resources. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. Access resources to help health care professionals do what they do bestcare for our members. Please update your browser if the service fails to run our website. Plus, you may qualify for financial help to lower your health coverage costs. Select a State Policies & Guidelines Medical Policies & Clinical UM Guidelines There are several factors that impact whether a service or procedure is covered under a member's benefit plan. Your dashboard may experience future loading problems if not resolved. If you would like to request a hard copy of an individual medical policy, please contact the member's health plan at the number on the back of their identification card. Please verify benefit coverage prior to rendering services. For discharge from an inpatient stay on a different date of service than the admission, see 99238-99239. Coverage decisions are subject to all terms and conditions of the applicable benefit plan, including specific exclusions and limitations, and to applicable state and/or federal law. We look forward to working with you to provide quality services to our members. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. The resources for our providers may differ between states. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. To get started, select the state you live in. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Medical policies can be highly technical and complex and are provided here for informational purposes. Additional medical policies may be developed from time to time and some may be withdrawn from use. As the nation's second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Talk to a health plan consultant: 833-828-6962 (TTY: 711) Mon-Fri, 8 a.m. to 8 p.m. ET/CT, 7 a.m. to 7 p.m. MT/PT. To stay covered, Medicaid members will need to take action. Members should discuss the information in the medical policies with their treating health care professionals. Contact will be made by an insurance agent or insurance company. Access eligibility and benefits information on the Availity* Portal OR. In Kentucky: Anthem Health Plans of Kentucky, Inc. The MCG guidelines we are licensed to use include ((1) Inpatient & Surgical Care (ISC), (2) General Recovery Care (GRG), (3) Recovery Facility Care (RFC), (4) Chronic Care (CC) and (5) Behavioral Health Care Guidelines (BHG). Anthem Blue Cross is the trade name of Blue Cross of California and Anthem Blue Cross Partnership Plan is the trade name of Blue Cross of California Partnership Plan, Inc. JavaScript is disabled. Choose your location to get started. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Anthem HealthKeepers Plus, offered by HealthKeepers, Inc., is a health plan that contracts with the Virginia Department of Medical Assistance Services to provide Medicaid benefits to enrollees. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Prior Authorization Lookup. This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all non-covered services (i.e., experimental procedures, cosmetic surgery, etc.) Where is the Precertification Lookup Tool located on Availity? Quickly and easily submit out-of-network claims online. Coverage decisions are subject to all terms and conditions of the applicable benefit plan, including specific exclusions and limitations, and to applicable state and/or federal law. You can also visit. The medical policies do not constitute medical advice or medical care. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and our members against contagious illnesses. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Other ways to access: If you are currently accessing the Pre-certification / Pre-Authorization Requirements list through your health plans public website, this option is still available for you. Medicare and some payers may allow providers of different specialties to report initial hospital services and require the admitting/supervising provider to append modifier AI. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. You can access the Precertification Lookup Tool through the Availity Portal. If your state isn't listed, check out bcbs.com to find coverage in your area. Our resources vary by state. Please verify benefit coverage prior to rendering services. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), whichunderwrites or administersthe PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC; Compcare Health Services Insurance Corporation (Compcare) underwritesor administers the HMO policies and Wisconsin Collaborative Insurance Company (WCIC) underwrites or administers Well Priority HMO or POS policies. A group NPI cannot be used as ordering NPI on a Medicare claim. Access your member ID card from our website or mobile app. Your browser is not supported. Large Group Vaccination is important in fighting against infectious diseases. It looks like you're outside the United States. With Codify by AAPC cross-reference tools, you can check common code pairings. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. Payments for services from a non-participating provider are generally sent to the member, except where federal or state mandates apply, or negotiated agreements are in place. Our small business plans offer a full range of health insurance options for groups with 2 to 50 or 100 employees, depending on your state. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Serving Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin. Use the Prior Authorization Lookup Tool within Availity or Contact the Customer Care Center: Outside Los Angeles County: 1-800-407-4627 Inside Los Angeles County: 1-888-285-7801 Customer Care Center hours are Monday to Friday 7 a.m. to 7 p.m. After hours, verify member eligibility by calling the 24/7 NurseLine at 1-800-224-0336. National Accounts, Posts about using health Insurance and managing your health, Collections of learning resources and links to services, For Sydney Health users connect with others and find care programs. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The medical policies generally apply to all of the Plans fully-insured benefits plans, although some local variations may exist. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. These learning opportunities will assist you in administering your patients health plan and provide you with the knowledge to best assist our members. This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all noncovered services (in other words, experimental procedures, cosmetic surgery, etc. Select Auth/Referral Inquiry or Authorizations. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Our research shows that subscribers using Codify by AAPC are 33% more productive. Inpatient services and non-participating providers always require prior authorization. February 2023 Anthem Provider News - Nevada, New ID cards for Anthem Blue Cross and Blue Shield members - Nevada, Telephonic-only care allowance extended through April 11, 2023 - Nevada, January 2020 Anthem Provider News and Important Updates - Nevada. Most Recently our office has been sent several recoupment notification from Anthem Blue Cross Blue Shield. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. There is no cost for our providers to register or to use any of the digital applications. Were committed to supporting you in providing quality care and services to the members in our network. It looks like you're outside the United States. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. You can also visit bcbs.com to find resources for other states. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Whether you need to check on a claim, pay a bill, or talk to a representative, you can easily access all your member features. We've provided the following resources to help you understand Anthem's prior authorization process and obtain authorization for your patients when it's required. Use the Prior Authorization tool within Availity OR. Inpatient services and non-participating providers always require prior authorization. If a prior authorization (PA) is required (indicates "yes" or "no") If there are PA conditions; If the service is a covered benefit (indicates "covered" or "not covered") Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. Jan 1, 2020 Anthem Blue Cross and Blue Shield Healthcare Solutions (Anthem) has an online tool that displays prior authorization guidelines to help you quickly determine whether certain services for Anthem members require a prior authorization. Explore our resources. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. Start by logging onto Availity.com and selecting the Register icon at the top of the home screen or use this link to access the registration page. Your browser is not supported. We currently don't offer resources in your area, but you can select an option below to see information for that state. Your browser is not supported. Medicare Complaints, Grievances & Appeals. Type a Current Procedural Terminology, or CPT, code or a Healthcare Common Procedure Coding System, or HCPCS, code in the space below to get started. Navigate to the Precertification Lookup Tool on the Availity Portal by selecting either 1) Payer Spaces or 2) Patient Registration from Availitys homepage. The purpose of this communication is the solicitation of insurance. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. Provider Medical Policies | Anthem.com Find information that's tailored for you. In Connecticut: Anthem Health Plans, Inc. For patients admitted and discharged from observation or inpatient status on the same date, see 99234-99236. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. The clinical UM guidelines published on this web site represent the clinical UM guidelines currently available to all health plans throughout our enterprise. Call Provider Services at 1-800-450-8753 (TTY 711) After hours, verify member eligibility by calling the 24/7 NurseLine at 1-800-300-8181 To request authorizations: From the Availity home page, select Patient Registration from the top navigation. Or The tool will tell you if that service needs . Treating health care professionals are solely responsible for diagnosis, treatment and medical advice. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE Managed Care, Inc. (RIT), Healthy Alliance Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Kentucky: Anthem Health Plans of Kentucky, Inc. As the monkeypox outbreak spreads across the United States, you may have a lot of questions and concerns. Weve got the latest advice, tips, and news to help you get the mostout of your benefits, find the best healthcare, and stay healthy. We maintain and annually update a List of Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) Codes (the Code List), which identifies all the items and services included within certain designated health services (DHS) categories or that may qualify for certain exceptions. It looks like you're outside the United States. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE Managed Care, Inc. (RIT), Healthy Alliance Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits.