For practice managers, healthcare providers, and billing teams, a critical policy update from Anthem Blue Cross and Blue Shield demands immediate attention. Effective April 1, 2025, Anthem will begin enforcing new coding requirements. This update mandates the use of anatomic modifiers for all relevant Anthem claims. This change aligns with the AMA CPT$^{\text{\circledR}}$ Manual and HCPCS Level II Manual guidelines. Understanding and implementing these requirements is essential to avoid costly claim denials and processing delays.
The Mandate: Why Anatomic Modifiers Are Required
Anthem will now require specific anatomic modifiers to clearly indicate the exact body part treated during a procedure. Claims that lack the correct modifier will be automatically denied. Consequently, this update ensures better clarity in clinical documentation and directly helps streamline claims adjudication. By accurately applying these modifiers, providers help Anthem determine the precise location and nature of the procedure, improving processing speed and accuracy.
Examples of Critical Anatomic Modifiers
Billing teams must accurately apply the following frequently used modifiers:
| Modifier | Meaning | Use Case |
| 50 | Bilateral procedure | Procedures performed on both sides of the body (e.g., both knees). |
| RT | Right side | Procedures performed solely on the right side. |
| LT | Left side | Procedures performed solely on the left side. |
| FA | Left hand, thumb | Specific digit procedures. |
Proactive Steps for Compliance
Practices must take proactive steps now to prepare for the enforcement date:
- Audit Workflows: Review your existing billing software and templates immediately. This ensures they fully support and prompt the use of anatomic modifiers.
- Educate Staff: Make sure your coding and billing teams receive thorough training. They must be able to identify and apply the correct Anthem anatomic modifiers to each relevant CPT or HCPCS code.
- Prevent Denials: Double-check that modifiers are present where required, especially for extremity-specific procedures.
- Know the Appeal Process: Familiarize your team with the Anthem Provider Manual for instructions on disputing claims denied due to missing or incorrect modifiers.
Conclusion
Mastering the accurate use of Anthem anatomic modifiers is mandatory for uninterrupted reimbursement. In summary, proactive training and auditing are the fastest ways to ensure compliance by the April 2025 deadline.