By Grant Achenbach, JD
Director of Government Relations

Several members have contacted ISMA recently with concerns about plans by Anthem Inc. to significantly reduce payments to physicians for some Clinical Lab and Surgical Pathology CPT codes, starting July 1.

Anthem slashed payment rates for many lab services in Missouri late last year and is planning similar cuts in Indiana and five other states, according to an article at www.ismanet.org/Anthemrates. Many payment rates in a “sample fee schedule” sent to clients of practice management firm Vachette Pathology were more than 70% lower than previously negotiated reimbursements and much lower than 2019 Centers for Medicare and Medicaid Services rates, the article said.

Anthem published a notice to Indiana providers on May 1, including a “sample” proposed fee schedule similar to those seen in other states. According to the notice, changes will take effect July 1 and will apply to the following networks: Blue Traditional, Blue Access, Blue Preferred Plans, the Indiana Exchange, HealthSync, Worker’s Compensation and any other networks with fees based on the those above (such as some Indiana Medicaid lab codes).

The notice also included a caveat that the sample fee schedule is not meant to be representative of all changes that will be made on July 1. Therefore, while ISMA does not yet know the full impact on Indiana physicians, we are engaged with relevant stakeholders and are monitoring the situation. If you received a notice from Anthem about these changes, be sure to read the account of the changes carefully, including the full schedule of planned payment changes online. If you have concerns about what you read, we encourage you to file a formal objection with Anthem.

ISMA will continue to update members on any new information we receive.