Anthem to reduce payment for COVID-19 lab codes

Health insurer Anthem recently announced that it intends to reduce physician payment for COVID-19 lab services when the COVID Public Health Emergency (PHE) expires May 11. Anthem will end special payment rates and return to its standard payment methodology for the following CPT codes:

• U0001
• U0002
• U0003
• U0004
• U0005
• 86328
• 86408
• 86409
• 86413
• 86769
• 87426
• 87428
• 87635
• 87636
• 87637
• 87811
• 0202U
• 0223U
• 0224U
• 0225U
• 0226U
• 0240U
• 0241U

Anthem, which operates in 14 states, will have to delay this change in some of its markets due to specific requirements. To determine when your state will be impacted, you can check Anthem’s “Provider News” website. Select your state from the “Change State” pop-up menu, then, under “Publication” click the “View Online” button to review recent state-specific Anthem articles.

When the PHE ends, Anthem will continue to reimburse in-network providers for COVID-19 testing, but will apply cost-sharing similar to other lab services, except in states that prohibit this. According to Anthem, physicians will be able to access state-specific revised fee schedules for the above codes on the website for Availity, an administrative contractor for Anthem.

Practices should verify the new payment amounts are sufficient to cover the costs of providing these lab tests and update their chargemaster if necessary. If you have questions regarding Anthem’s revised payment amounts, you can contact your local Anthem network consultant. To find your consultant, follow this link and select your state.

— Brennan Cantrell, AAFP Commercial Health Insurance Strategist

Posted on March 17, 2023