Anthem to fix Medicare HMO error; new CPT code set released
By Carol Hoppe
President and CEO
MedLucid Solutions 

Anthem recently sent a letter to many Indiana Medicare HMO members explaining that their primary care provider (PCP) was out-of-network. These letters were sent in error. Also, earlier this month, the AMA released its updated Current Procedural Terminology (CPT®) code set for 2023.

Anthem data system error
Here’s how the Anthem error happened: Many Indiana Medicare HMO PCPs were inadvertently changed from a PCP to a specialist in Anthem’s data systems. As a result, members assigned to those PCPs were reassigned to a new PCP and were sent a letter indicating the PCP change and, in many cases, a new ID card.

In response, Anthem is:
  • Moving all affected members back to their previous PCP.
  • Contacting members as soon as possible via email and phone to make them aware of this issue and next steps.
  • Following up with a letter and new ID cards (if needed) to all affected members.
In the meantime, affected members should:
  • Continue to use their existing (original) ID cards.
  • Keep existing medical appointments.
  • Visit their PCP when they need medical care.
Anthem apologizes for any potential inconvenience to primary care physicians, office staff and patients.

2023 CPT code set 
On Sept. 9, the AMA  released its 2023 Current Procedural Terminology (CPT®) code set. In a news release, the AMA noted the new codes included “burden-reducing revisions to the codes and guidelines for most evaluation and management (E/M) services.” 

 “Based on the 2021 revisions made to the E/M codes for office visit services, the new modifications make coding and documentation easier and more flexible for other E/M services, freeing physicians and care teams from time-wasting administrative tasks that are clinically irrelevant to providing high-quality care to patients,” the AMA news release said. “The new modifications to the E/M codes extend to inpatient and observation care services, consultations, emergency department services, nursing facility services, home and residence services and prolonged services.” 

The new E/M code modifications are now online here. 

The AMA has also created resources to help physicians and practices transition to the revised codes and guidelines. 

The complete list is available here.