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Thread: Anthem Federal Bi-lateral billing guidelines

  1. #1
    Join Date
    Apr 2007
    Everett, WA

    Default Anthem Federal Bi-lateral billing guidelines

    AAPC: Back to School
    Working on trying to find an answer to this. Why must it be so "secretive?" Customer service has told us to submit units with no modifier 50, although we have used it successfully in the past up until February of this year. CPT code is 64612. Agent said they have their own guidelines and do not necessarily abide by MCR. I've contacted our Provider Support Rep who referred me to another agent specializing with Federal and I've still received no answer to my question. So, customer service says one thing, past claims payments says another, and now can't get an answer from the one who is supposed to know. What should be my next step to end this run-around?

    ---Suzanne E. Byrum, CPC

  2. #2

    Talking Answer to question

    I assume you are using 50 to indicate a bilateral procedure was performed. However most insurance companies want the procedure on two line items and specifiy RT or LT. So it would look like this 64612-RT and 64612-LT. Try that and let me know if it works for you. Remember that most bilateral procedures insurance companies want to see 2 line items vs. just 64612-50.

    Hope that helps you
    Angela Niemi-CFPC

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