Anthem will no longer reimburse facilities separately for moderate sedation services beginning July 1, instead bundling reimbursement into the overall procedure or facility fee, according to an April 1 policy update.
The insurer said the change is consistent with CMS outpatient prospective payment system methodology and is intended to eliminate duplicate payments for services already included in the primary procedure reimbursement.
The policy change affects facilities in Georgia, Indiana, Missouri, Nevada, New Hampshire and Ohio. Participating providers are prohibited from balance billing members based on the change.
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