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Anthem Blue Cross to implement restrictive outpatient advanced radiology policy

October 04, 2017
Area(s) of Interest: Commercial Payors Payor Issues and Reimbursement 


Effective December 1, 2017, Anthem Blue Cross will implement a new policy restricting outpatient advanced radiologic imaging procedures in the hospital setting. The updated policy, originally scheduled to become effective October 1 but recently delayed, indicates that advanced radiologic imaging procedures in the hospital outpatient department are only considered medically necessary under the following circumstances:

  • If services are only available in the hospital setting; or
  • The patient requires obstetrical observation; or
  • The patient is receiving perinatology services; or
  • There are no other geographically accessible appropriate alternative sites to perform the service, including in instances where:
  • General anesthesia or moderate or deep sedation is required and unavailable at a freestanding facility; or
  • Patient size prohibits the use of equipment at a freestanding facility; or
  • The patient has documented history of claustrophobia.

 

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