January 03, 2022
Anthem Blue Cross has clarified that for California providers, it will continue to reimburse telehealth services billed with either POS 02 or POS 10 at the in-office place of service rate, as currently required by the California Department of Managed Health Care (DMHC).
In its December 2021 Anthem Provider News, Anthem Blue Cross announced a reimbursement policy update, “Virtual Visits – professional and facility,” which indicated that telehealth services billed with place of service (POS) 02 (telehealth provided other than in patient’s home) or new POS 10 (telehealth provided in patient’s home) would be reimbursed at the non-office place of service rate. Because this new policy does not align with California’s telehealth parity requirements, the California Medical Association (CMA) asked Anthem to clarify whether the new policy applies to California physicians. Anthem agreed that this was an error and has issued a clarification notice.
The clarification issued by Anthem aligns with the DMHC all plan letter (APL) issued on September 4, 2020, which reminded DMHC-regulated health plans of the continued requirement to reimburse providers at the same rate for telehealth services, including telephonic visits, as they would for services provided in person. This APL confirmed that the prior APLs (20-009 and 20-013) remain in effect for the duration of California’s declared state of emergency or until further notice from DMHC, whichever is earlier.
For specific details about Anthem’s reimbursement policies, visit the anthem.com/ca website.