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Central Region Clinical Claim Edit

Central Region Clinical Claim Edit 2025

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The document outlines Anthem Blue Cross and Blue Shield's Central Region Clinical Claim Edit #761, which pertains to the separate reimbursement of Counseling Risk Factor Reduction and Behavior Change Intervention services (codes 99401-99412, 99420) when reported alongside Evaluation and Management (E/M) services (codes 99201-99255). It specifies that these counseling codes are distinct from E/M services and can be reimbursed separately if performed on the same day, as per guidelines from the National Correct Coding Initiative and the 2012 CPT manual.

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Claim adjudication is the process insurance companies use to evaluate medical claims to determine whether they are valid and eligible for reimbursement based on the patients insurance policy.

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