Anthem Bundles Casting with Foot Orthoses


Per New Anthem Blue Cross Guidelines:

Procedure codes S0395 (casting), A4580 (cast supplies) and A4590 (special casting materials) are considered mutually exclusive when billed with L3000, L3010, L3020 and L3030 (custom foot orthotics); therefore, beginning for some claims processed November 1, 2015 and applicable for all claims processed on or after November 16, 2105, codes S0395 and A4580 are no longer eligible for separate reimbursement when billed with L3000, L3010, L3020 and L3030.

CPMA believes this new policy to be utterly unacceptable, and is currently in serious discussions with Anthem over such an egregious payment practice. In the interim, CPMA's Health Policy Committee is encouraging all members who receive an EOB with this excuse as the reason for denial of properly billed claims to APPEAL the denial. Clearly state in the subject line and the first sentence of the letter that this is an APPEAL.

Payors are required to acknowledge receipt of a written ap­peal within two working days for electronic appeals or 15 working days for paper appeals. The payor is required to respond to written appeals submitted by providers within 45 working days of receipt, and they must report to the Department of Managed Health Care, on an annual basis, the nature and volume of appeals received [28 C.C.R SS1300.71.38 (e)(f)(k)].

Please copy California Podiatric Medical Association - Health Policy Committee on all such appeals. Mail to CPMA, 2430 K Street, Suite 200, Sacramento, CA 95816 with ATTENTION to Health Policy Committee. Or, fax to 916-448-0258 with ATTENTION: Health Policy Committee