Effective April 1, 2025, Anthem Blue Cross and Blue Shield will enforce new coding guidelines requiring anatomic modifiers (50, RT, LT) for claims. These updates align with the AMA CPT® Manual and HCPCS Level II Manual.
Key Changes:
- Anatomic modifiers must be appended to procedure codes to specify the body part treated.
- Claims without the correct modifiers will be denied.
Examples of Anatomic Modifiers:
- FA: Left hand, thumb
- TA: Left foot, great toe
Action Steps:
- Ensure proper use of modifiers 50, RT, and LT to avoid claim denials.
- Review the Provider Manual for the claims dispute process if needed.