Accountable Health Care IPA
Memorandum
**VERY IMPORTANT**PLEASE READ**
Date:
March 01, 2012
To:
Providers
From:
Quality Management Department
RE:
Anthem Blue Cross Proprietary Codes
Child Health and Disability Prevention Program
National Standard Codes Replacing
Anthem Blue Cross Proprietary Codes
IPA Bulletin
This bulletin is an update about information in Anthem Blue Cross’ State Sponsored
Business Provider Operations Manual (Manual). For access to the latest Manual, go
online to www.anthem.com/ca.
Effective March 1, 2012 Anthem Blue Cross will require providers and Independent Practice
Associations (IPAs) to use the national standard CPT-4/HCPCS codes. We will also require
that the Medi-Cal local modifier SL (applicable with Vaccines for Children [VFC] vaccine
codes) be used for all Child Health and Disability Prevention (CHDP) program services.
If your contract mandates that you pay CHDP services, please update your systems with the
following code changes in a timely manner so that your providers can properly submit claims
under the new coding guidelines as of March 1, 2012. All claims submitted with this date of
service and thereafter must utilize the new codes. Additionally, the PM-160 “Information
Only” forms are to be mailed as previously required, and please ensure that these forms are
legible.
Any additional questions and more details of the exact code cross walking can be obtained
from your local Community Resource Coordinator (CRC). Telephone contact information is
listed at the end of this bulletin. Please ensure that your IT and claims departments receive
this information.
References:
Anthem BlueCross State Sponsored Business Provider Bulletin
http://www.anthem.com/ca
Guidelines for accepting CHDP Claims
When accepting claims data for CHDP services, please use the following guidelines to
process your encounters:

For Primary Diagnosis, please use diagnosis code V20.2 or V70.0

Primary Care Physicians: well visit services with range 99800-99808 will be
replaced with standard CPT-4 range 99381 – 99385 for new patients and 9939199395 for established patients.

Health Assessment Providers (School Based Clinics and Local Health Departments)
well visit services with range 99810 – 99818 will be replaced with standard CPT-4
ranges
99381 – 99385 for new patients and 99391-99395 for established patients.
Health Screening Procedures with range 99820-99825 will be replaced with the following
CPT-4 standard codes:
CPT-4 Codes
S0612
99173
92552
86580
Description
Pelvic Exam-19 years up to 22 years of age
Snellen Eye Test or Equivalent Visual Acuity Test age 3 yrs through 18 years
of age
Bi-Aural Hearing Tests-Audiometric: Pure Tone Audiometry
PPD Screening-TB: Mantoux Test
For CHDP only, please continue to use HCPCS code D1203 for topical application of
fluoride on children younger than 6 years of age and up to three times in a 12- month period.
(This is a medical benefit and not dental.)
Clinical Laboratory Test services with range 99830-99840 will be replaced with standard
CPT-4 codes. All clinical labs must be CHDP-certified and have an active Clinical
Laboratory Improvement Amendments (CLIA) certification. There are limited lab tests that
can be drawn and analyzed in the provider’s office and providers are required to have a CLIA
Waiver certification to render these services. Additionally, there are limited lab tests by
providers that are drawn in the office and sent to the lab to receive a reimbursement.
Please use the following CPT-4 standard codes appropriately when processing provider
claims for the correct services rendered.
References:
Anthem BlueCross State Sponsored Business Provider Bulletin
http://www.anthem.com/ca
Clinical Laboratories: collection and analysis- Place of Service 81 (process as global
except when modifier is noted)
CPT-4 Codes
82947
84030
81002 or 81003
81007
85660
82465
83655 (26/TC)
86592
87590
88150
87110
87177
Description
Blood glucose assay
Phenylketonuria (PKU) blood test- (under 1 month of age)
Urine “Dipstick”
Urinalysis, routine, complete
Sickle Cell Status (Hemoglobin Electrophoresis)
Total Cholesterol
Lead Blood Level
VDRL, RPR, or ART
Gonorrhea (GC) test
Pap Smear
Chlamydia Test
Ova and/or Parasites
Primary Care and Health Assessment Providers: specimen collected and analyzed in
office requires CLIA Waiver (process as global except when modifier is noted)
CPT-4 Codes
82947
83026 or 85018
84030
81002 or 81003
81007
82465
83655 (26/TC)*
Description
Blood glucose assay
Hemoglobin or Hemotocrit
Phenylketonuria (PKU) blood test- (under 1 month of age)
Urine “Dipstick”
Urinalysis, routine, complete
Total Cholesterol
Lead Blood Level
*When certified to perform Lead Blood Level (83655) test in the office, bill code without
modifiers when performing both professional and technical components. For providers
without certification, use modifier 26 when performing the professional component only.
References:
Anthem BlueCross State Sponsored Business Provider Bulletin
http://www.anthem.com/ca
Primary Care and Health Assessment Providers: collection and handling of specimen
sent to lab for analysis (process as global except when modifier is noted)
CPT-4 Codes
82947
83026 or 85018
85660
82465
83655.26
86592
87590
87110
Description
Blood glucose assay
Hemoglobin or Hemotocrit
Sickle Cell Status (Hemoglobin Electrophoresis)
Total Cholesterol
Lead Blood Level
VDRL, RPR, or ART
Gonorrhea (GC) test
Chlamydia Test
Immunizations and vaccines with range 99845-99868 will be replaced with standard CPT-4
codes. When processing claims for immunizations obtained from the VFC Program, the
Medi-Cal local modifier SL is required with the appropriate CPT-4 code on each line. When
the immunization is not covered by VFC, do not use the SL modifier.
When processing claims with CHDP vaccines, whether VFC-related or not, please remember
to process claims lines with the standard administration fee CPT-4 codes 90460-90461 or
90471-90474 appropriately.
References:
Anthem BlueCross State Sponsored Business Provider Bulletin
http://www.anthem.com/ca
For More Information
You can find related information on our website; go to www.anthem.com/ca. Select Other
Anthem Websites: Providers on the bottom right, and under the heading Learn More, click
State Sponsored Plans. Under Forms and Tools, select the link for CHDP Proprietary
Codes Cross Walked to National Standard Codes.
In the future, you’ll be able to find additional related information in our Provider Operations
Manual; go to www.anthem.com/ca. Select Other Anthem Websites: Providers on the
bottom right, and under the heading Learn More, click State Sponsored Plans. Under
Provider Communications, click Provider Operations Manuals and Important Updates,
and then select the link for the provider operations manual for Medi-Cal.
If you have specific questions or concerns, please contact your local CRC:
Fresno/Madera
Los Angeles
Sacramento/Bay Area
Stanislaus/San Joaquin
Tulare/Kings
1-559-488-1380
1-818-655-1255
1-916-325-4200
1-209-558-2762
1-559-733-6578
References:
Anthem BlueCross State Sponsored Business Provider Bulletin
http://www.anthem.com/ca