Anthem BC Requires Modifiers on Outpatient Therapy Claims

May 17, 2021
 / 
Rick Gawenda
 / 

Anthem BC has revised their policy concerning modifiers that are required on outpatient physical, occupational and speech therapy claims. Failure to append the applicable modifier will result in nonpayment of your claim. Anthem BC services the following states:

  • California
  • Colorado
  • Connecticut
  • Georgia
  • Indiana
  • Kentucky
  • Maine
  • Missouri
  • New Hampshire
  • Nevada
  • New York
  • Ohio
  • Virginia
  • Wisconsin

To access the policy, click

The content here is for members only log in here or sign up.

I hope you found this article helpful. Thank you for being a Gold Member!


All material posted on our website is the intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without the prior written approval of Gawenda Seminars & Consulting, Inc.

This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

  1. Will this change of adding the applicable GP modifier for physical therapy services be needed for all BCBS plans or just the Anthem BCBS?

    1. This article is specific to Anthem BC and the states Anthem BC serves. If you have a different BC carrier, you would need to follow their policy(ies) pertaining to therapy services.

  2. We treat Anthem BCBS in Alabama, but the patients policies originate in Georgia, Ohio etc. Do we follow Alabama rules or the state in which the insurance originates?

  3. I cannot access the policy. Under reimbursement policy the only option to select is “contact provider relations”. Is there another place to access these policies? Or could you tell us the effective date of this new modifier change? Thanks.

  4. Anthem owns many MCO’s; thus expect to see this requirement in Anthem led State Medicaid Managed Care populations.

  5. Cannot access the policy. The only option under reimbursement policy when on the VA Anthem site is contact provider relations. It’s not giving the options that you are telling us to choose?

    1. I couldn’t find the modifier guidelines either. And it doesn’t come up in the search box, unfortunately!

      1. Some states may not allow you to access the reimbursement policies online and requires you to contact Provider Relations. If that is true with your state, select California as your state and then follow the instructions above.

  6. Unable to locate the information based on the instructions as well – our office is located in Virginia. But if we’re just adding GP to claims, that I can do!

    1. Some states may not allow you to access the reimbursement policies online and requires you to contact Provider Relations. If that is true with your state, select California as your state and then follow the instructions above.

  7. so if I am reading the policy correctly, the changes for those states now appear to include their commercial plans for GO, GN, GP? Correct? For Wisconsin, I am not seeing their typical insurance-type headings for what category this rule applies (i.e. Commercial, Medicare, Medicaid financial class).

  8. I am hearing that Anthem will begin reimbursing differently for hospital based outpatient clinics versus private practice. I have tried to find information about this and only have found a little regarding medical necessity for a hospital based outpatient clinic will need to be determined. Do you know anything else about this or can point me in the correct direction? Thanks!

    1. Typically, most insurances, besides Medicare, pay hospitals a higher rate for outpatient therapy compared to a private practice. It would all depend on what hospitals negotiate in their contracts. There can also be a difference between a hospital-based OP therapy clinic versus an off-site clinic with a separate TAX ID number that is owned by the hospital.