UPDATE TO IMPORTANT INFORMATION REGARDING ANTHEM FEE SCHEDULES
This is a follow-up to the Network eUPDATE, “Important information regarding Anthem fee
schedules,” that was distributed on September 30, 2016.
What follows, starting on the next page, is a sample schedule of frequently submitted CPT® codes
and their maximum allowable amount effective for dates of service on and after January 1, 2017. This
listing is not meant to be representative of all changes that are being made to the Anthem fee
schedules. Reimbursement for some codes may be decreasing, some codes may be increasing, and
others may remain the same.
If you have a question about any code you do not see on this list, we encourage you to access the
on-line fee schedule tool at MyAnthem via the Availity Web Portal. (Go to
www.anthem.com>Providers> (enter Indiana) and log in to Availity on the left side of the provider
home page. Or go to www.availity.com and select the Anthem Provider Portal. Please note that the
online fee schedules provide allowables for current as well as historical codes and rates. Fee
schedules with an effective date of January 1, 2017 may be available on-line at My Anthem on or
after October 15, 2016.
Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross and Blue Shield
Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are
registered marks of the Blue Cross and Blue Shield Association.
10-16
Anthem Fee Reimbursement Effective January 1, 2017
Blue Access
Blue Access
Blue Traditional Blue Traditional Blue Preferred Blue Preferred
Procedure Code
Description
Non-facility
Facility
Non-facility
Facility
Integumentary
10120
10121
11042
11042
11400
12002
12020
17000
17110
Musculoskeletal
20550
20610
26010
26011
26160
26160
28289
Podiatry
28270
28289
Incision & Removal Fb Skin Simple
Incs Remove Fb Subq Tissue Comp
$
172.46 $
75.57 $
172.46 $
75.57
$
311.54 $
192.59 $
311.54 $
192.59
Debridement, subcutaneous tissue
$
132.44 $
62.39 $
132.44 $
62.39
Debridement, subcutaneous tissue
Exc,Benign Lesion including margins,except skin tag
Rep Simple Scalp Etc 2.5-7.5cm
Closure Superfic Wound Dehiscence
$
132.44 $
62.39 $
132.44 $
62.39
$
139.86 $
82.54 $
139.86 $
82.54
$
205.66 $
124.53 $
205.66 $
124.53
$
327.55 $
193.55 $
327.55 $
193.55
Destruct premalg lesion
$
76.07 $
52.99 $
76.07 $
52.99
Destruct b9 lesion, 1-14
$
106.25 $
54.27 $
106.25 $
54.27
Inj tendon sheath/ligament
$
77.76 $
53.87 $
77.76 $
53.87
Drain/inject, joint/bursa
$
89.11 $
66.07 $
89.11 $
66.07
Drain Finger Abscess
Drainage Finger Abscess;complicated-Eg,F
$
298.38 $
94.39 $
298.38 $
94.39
$
439.63 $
194.63 $
439.63 $
194.63
317.06
Exc.Les-Tend.Sheath/Capsule-Hnd/Fng
$
1,050.00 $
317.06 $
1,050.00 $
Exc.Les-Tend.Sheath/Capsule-Hnd/Fng
$
1,050.00 $
317.06 $
1,050.00 $
317.06
Hallux rigidus correction with cheilectomy, debridement
$
709.94 $
488.20 $
709.94 $
488.20
Capsulotomy-Contracture Metatarsophalan
Hallux rigidus correction with cheilectomy, debridement
$
$
476.76 $
709.94 $
376.48 $
488.20 $
476.76 $
709.94 $
376.48
488.20
ENT
30140
30140
31237
31296
31296
31297
31575
Digestive
40812
45378
45380
45385
Resect inferior turbinate
$
1,156.62 $
544.28 $
1,156.62 $
544.28
Submucous resection inferior turbinate,
$
1,156.62 $
544.28 $
1,156.62 $
544.28
242.42
Nasal Sinus Endoscopy Surgical with Biopsy, Polypectomy
$
300.60 $
242.42 $
300.60 $
Nasal/sinus endoscopy, surgical; with dilation
$
5,407.79 $
251.20 $
5,407.79 $
251.20
Nasal/sinus endoscopy, surgical; with dilation
Nasal/sinus endoscopy, surgical; with dilation
$
$
5,407.79 $
5,309.59 $
251.20 $
205.89 $
5,407.79 $
5,309.59 $
251.20
205.89
laryngoscopy flexible fiberoptic
$
145.26 $
99.51 $
145.26 $
99.51
Excise/repair mouth lesion
$
336.32 $
251.08 $
336.32 $
251.08
Diagnostic colonoscopy
$
519.26 $
297.75 $
519.26 $
297.75
Colonoscopy and biopsy
$
623.48 $
358.77 $
623.48 $
358.77
Colsc flx prox splenic flxr rmvl les snare tq
$
704.10 $
425.99 $
704.10 $
425.99
Maternity & OB/Gyn
58550
Laparoscopy surgical,with vaginal hysterectomy
58552
Laparoscopy, surg, w/vaginal hyster, for uterus 250 grams
58561
Hysteroscopy surg with removal of leiomyomata
58563
Hysteroscopy surg with endometrial ablation
59400
Obstetrical care
59510
Obstetrical care
Nervous
62311
64405
64483
64721
Radiology
71020
7102026
73630
7363026
74000
7400026
77057
7705726
$
$
$
$
1,213.60
1,327.01
1,077.60
3,197.32
$
$
$
$
1,213.60
1,327.01
682.40
425.57
$
$
$
$
1,213.60
1,327.01
1,077.60
3,197.32
$
$
$
$
1,213.60
1,327.01
682.40
425.57
$
2,200.00 $
2,200.00 $
2,200.00 $
2,200.00
$
2,200.00 $
2,200.00 $
2,200.00 $
2,200.00
Inject spine l/s (cd)
$
230.44 $
80.45 $
230.44 $
80.45
Njx anes grter occipital nrv
$
162.50 $
100.04 $
162.50 $
100.04
Inj foramen epidural l/s
$
261.70 $
102.74 $
261.70 $
102.74
Neurolysis/Transposit Median
$
490.67 $
466.35 $
490.67 $
466.35
radex ch 2 views frnt&lat
$
59.80 $
32.75 $
59.80 $
32.75
radex ch 2 views frnt&lat
$
11.80 $
11.80 $
11.80 $
11.80
X-Ray Foot; Complete, Min. of 3 Vws
$
34.40 $
30.31 $
34.40 $
30.31
X-Ray Foot; Complete, Min. of 3 Vws
$
11.40 $
11.40 $
11.40 $
11.40
radex abd 1 anteropost view
$
51.90 $
29.09 $
51.90 $
29.09
radex abd 1 anteropost view
$
11.90 $
11.90 $
11.90 $
11.90
screening mammography bilateral
$
123.25 $
123.25 $
123.25 $
123.25
screening mammography bilateral
$
35.40 $
35.40 $
35.40 $
35.40
$
3.77 $
3.77 $
3.77 $
3.77
$
3.03 $
3.03 $
3.03 $
3.03
$
8.03 $
8.03 $
8.03 $
8.03
$
3.68 $
3.68 $
3.68 $
3.68
Clinical Laboratory
81001
urnls dip stick/tablet rgnt auto mic
81002
urnls dip stick/tablet rgnt non-auto w/o mic
81025
urine pregnancy tst vis color cmprsn meths
85025
bld# compl auto hhrwp&auto diffial
Surgical Pathology
88302
Tissue exam by pathologist
88304
Tissue exam by pathologist
88305
Tissue exam by pathologist
88342
Insitu hybridization, auto
Vaccines
90670
90680
90716
90734
$
50.17 $
50.17 $
50.17 $
50.17
$
49.30 $
49.30 $
49.30 $
49.30
$
107.50 $
107.50 $
107.50 $
107.50
$
102.30 $
102.30 $
102.30 $
102.30
181.06
Pneumococcal conj vaccine 13 valent im
$
181.06 $
181.06 $
181.06 $
Rotavirus vaccine pentavalent 3 dose live
$
86.00 $
86.00 $
86.00 $
86.00
varicella virus vaccine live subq
$
116.00 $
116.00 $
116.00 $
116.00
Meningococcal conjugate vaccine
$
132.00 $
132.00 $
132.00 $
132.00
$
25.42 $
25.42 $
25.42 $
25.42
$
12.51 $
12.51 $
12.51 $
12.51
$
25.42 $
25.42 $
25.42 $
25.42
$
12.51 $
12.51 $
12.51 $
12.51
Vaccine Administration
90471
Immunization admin
90472
Immunization admin, each add
90473
Immune admin oral/nasal
90474
Immune admin oral/nasal addl
Behavioral Health (MD level)
90832
Psychotherapy, 30 min with pat and/or fam member
90833
Psychotherapy, 30 min w pat/fam member w E&M
90834
Psychotherapy, 45 min w pat and/or fam member
90837
Psychotherapy, 60 minutes w patient and/or family member
90847
Family psychotherapy, (conjoint psychotherapy)
$
65.72 $
52.91 $
65.72 $
52.91
$
24.73 $
24.73 $
24.73 $
24.73
$
88.19 $
80.77 $
88.19 $
80.77
$
129.95 $
121.83 $
129.95 $
121.83
$
104.16 $
95.91 $
104.16 $
95.91
Hearing
92507
92551
92557
92567
Comprehensive hearing test
$
47.10 $
45.40 $
47.10 $
45.40
Tympanometry
$
20.70 $
19.24 $
20.70 $
19.24
Sleep Studies
95808
95810
95811
Polysomnography; Sleep Staging with 1 to 3
Polysomnography; age 6n yrs or older, sleep staging with 4
Polysomnography; age 6 yrs or older, sleep stag'g w 4 or
$
$
$
591.47 $
586.26 $
616.00 $
591.47 $
586.26 $
616.00 $
591.47 $
586.26 $
616.00 $
591.47
586.26
616.00
Neurology
95907
95908
95909
95910
Speech/hearing therapy
$
67.78 $
67.78 $
67.78 $
67.78
Screening Test,Pure Tone, Air Only
$
13.15 $
13.15 $
13.15 $
13.15
Nerve condution studies; 1-2 studies
$
111.36 $
111.36 $
111.36 $
111.36
Nerve condution studies; 3-4 studies
$
136.97 $
136.97 $
136.97 $
136.97
Nerve condution studies; 5-6 studies
$
164.36 $
164.36 $
164.36 $
164.36
Nerve condution studies; 7-8 studies
$
216.96 $
216.96 $
216.96 $
216.96
Physical Therapy
Pt evaluation
97001
97012
Mechanical traction therapy
97035
Ultrasound therapy
97110
Therapeutic exercises
Manual therapy
97140
97530
Therapeutic activities, each 15 minutes
$
55.21 $
55.21 $
55.21 $
55.21
$
11.79 $
11.79 $
11.79 $
11.79
$
9.29 $
9.29 $
9.29 $
9.29
$
23.55 $
23.55 $
23.55 $
23.55
$
22.07 $
22.07 $
22.07 $
22.07
$
25.71 $
25.71 $
25.71 $
25.71
Evaluation & Management
99202
Office/outpatient visit, new
$
99203
Office/outpatient visit, new
$
99204
Office/outpatient visit, new
$
99205
Office/outpatient visit, new
$
99212
Office/outpatient visit, est
$
99213
Office/outpatient visit, est
$
99214
Office/outpatient visit, est
$
99215
Office/outpatient visit, est
$
Periodic preventive evaluation and management; under 1 Yr of ag $
99391
99392
Periodic evaluation and mangement; early childhood age 1-4 yrs $
99393
Periodic evaluation and management; age 5-11 years of age
$
Periodic preventive evaluation and management; 12-17 yrs of age $
99394
99395
Periodic preventive evaluation and management; 18-39 yrs of age $
Periodic preventive evaluation and management; 40-64 yrs of age $
99396
Periodic preventive evaluation and management; 65 yrs of age or $
99397
73.29 $
73.29 $
73.29 $
73.29
106.19 $
106.19 $
106.19 $
106.19
162.17 $
162.17 $
162.17 $
162.17
201.30 $
201.30 $
201.30 $
201.30
43.00 $
43.00 $
43.00 $
43.00
71.77 $
71.77 $
71.77 $
71.77
105.54 $
105.54 $
105.54 $
105.54
141.38 $
141.38 $
141.38 $
141.38
100.71 $
100.71 $
100.71 $
100.71
108.98 $
108.98 $
108.98 $
108.98
108.98 $
108.98 $
108.98 $
108.98
124.43 $
124.43 $
124.43 $
124.43
116.76 $
116.76 $
116.76 $
116.76
131.20 $
131.20 $
131.20 $
131.20
146.65 $
146.65 $
146.65 $
146.65
HCPCS
A4556
A4604
A9500
B4035
B4161
E0730
V2531
Electrodes (e.g., apnea monitor), per pair
$
7.28 $
7.28 $
7.28 $
7.28
Tubing with integrated heating element
$
46.77 $
46.77 $
46.77 $
46.77
Technetium tc-99m sestamibi, diagnostic
$
75.00 $
75.00 $
75.00 $
75.00
Enteral feeding supply kit; pump fed, per day,
$
7.66 $
7.66 $
7.66 $
7.66
Enteral formula, for pediatrics, hydrolyzed/amino acids
$
1.60 $
1.60 $
1.60 $
1.60
Transcutaneous electrical nerve stimulation
$
220.41 $
220.41 $
220.41 $
220.41
Contact lens, scleral, gas permeable, per lens
$
775.77 $
775.77 $
775.77 $
775.77
$
$
42.00 $
35.70 $
42.00 $
35.70 $
42.00 $
35.70 $
42.00
35.70
Anesthesia
MD Reimbursement per unit
CRNA Reimbursement per unit
*Non-MD mental health practitioners such as LCSW, LMFT, LMHC, etc are reimbursed at 80% of the MD fee schedule
*Midlevel practitioners such as NP, PA, etc are reimbursed at 85% of the MD fee schedule except for HCPCS and other codes.
Refer to the online fee schedule for specific code reimbursements.