APMA, ACFAS, AAOS, and AOFAS recently held a call with Anthem and its contractor, AIM, to discuss their new Site of Care review initiative.
On January 1, 2022, Anthem is launching a Site of Care review initiative that will apply to a range of MSK procedures, some of which are utilized by foot and ankle surgeons. The site of care review is to determine whether the procedure can be performed in an ambulatory surgical center (ASC) rather than a hospital outpatient department (HOPD). This initiative will only apply to Anthem’s commercial plans in Colorado, Georgia, Indiana, Kentucky, and Ohio.
According to Anthem, under this initiative “prior authorization will now also be required for the clinical appropriateness of the site in which the procedure is performed (site of care) on select CPT procedures.” Read the list of impacted procedures.
APMA’s Anthem Workgroup meets this week and will continue to review this issue, among others, and share APMA member concerns directly with Anthem.