June 21, 2019
Update On Changes to Anthem Prudent Buyer Fee Schedule

We previously informed you that Anthem sent letters to providers under contract with the Anthem Blue Cross Prudent Buyer Plan announcing changes to their fee schedule effective 7/1/19. Though the letter indicates the changes are necessary to allow greater reimbursement for primary care and E & M services they don't indicate that many high volume anatomic pathology services are subject to significant reductions as much as 50-60%.

If you are a participating provider with Anthem Prudent Buyer Plan and have not received a letter and attached fee schedule you should contact the Network Relations Staff at CAContractSupport@Anthem.com. Here is a link to the fee schedule and you will find the pathology codes beginning on page 110. You can also go to www.availity.com. If a group is not affected by the change, there will be no rate available as the current fee/rate.

During the call we obviously complained about the magnitude of the rate reductions for many common AP procedures and that they often were below Medicare rates. As we had assumed, they were using rates that may currently being paid to large national labs in other parts of the country. We indicated that those rates are not comparable to the hospital setting and further may be a marketing tool for large labs to obtain the broader array of clinical lab testing. They stated that they to date had received few contract termination notices. We replied that it is very likely that many pathology groups were either not aware of the magnitude of the changes are were not in receipt of notice of the change.

Anthem did indicate that they would review our concerns with the rate reductions, but we have no assurance at this point that any changes will be made. We will continue our efforts, but each group should review their own situation and take action as appropriate. We will provide updated information as it becomes available.

CSP 72nd Annual Meeting - Save the Date!

December 3 - 7, 2019
Hyatt Regency San Francisco
5 Embarcadero Center, San Francisco, CA 94111


California Society of Pathologists
One Capitol Mall Suite 800
Sacramento, CA 95814 
Tel : 916-446-6001
Fax :  916-444-7462