CurrentAnthemPolicy G-06032

Duplicate or Subsequent Services on the Same Date of Service

Governs reimbursement for duplicate or subsequent services provided to Anthem HealthKeepers Plus Medicaid members on the same date of service and explains when such services will be reimbursed if billed with appropriate modifiers; applies to providers submitting claims to HealthKeepers, Inc.

Policy Summary

PayerAnthem

PolicyDuplicate or Subsequent Services on the Same Date of Service

Policy CodePolicy G-06032

Change TypeNo material change

Effective DateApr 11, 2022

Next Review Date

Key ActionSubmit duplicate or subsequent services with appropriate modifiers; claims lacking appropriate modifiers may be denied or recouped.

SourceLink

allows reimbursementpolicy stance on duplicates/subsequent services

deniedclaim handling when modifier missing

>20modifiers listed in Related Coding

HealthKeepers Pluspayer/product scope

Reimbursement for Duplicate or Subsequent Services

Duplicate/subsequent reimbursement criteria

Reimbursement is allowed when proper modifiers demonstrate the service is distinct, repeated, or otherwise billable; otherwise claims may be denied or reviewed.

Service is billed with an appropriate modifier that indicates the service was distinct, repeated, or otherwise billable on the same date of service.

Modifier selection must align with the modifiers listed in the Related Coding section (e.g., 25, 59, 62, 66, 76, 77, 80, 81, 82, 91, AS, GG, GH, XE, XP, XS, XU).

Refer to the Related Coding section for full modifier descriptions and applicability.

Claims billed without the appropriate modifier(s) for duplicate or subsequent services may be denied or recouped and will be subject to review.

When billed on the same claim

Policy Summary

PayerAnthem

PolicyDuplicate or Subsequent Services on the Same Date of Service

Policy CodePolicy G-06032

Change TypeNo material change

Effective DateApr 11, 2022

Next Review Date

Key ActionSubmit duplicate or subsequent services with appropriate modifiers; claims lacking appropriate modifiers may be denied or recouped.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Related Modifiers and Code Guidance

Modifiers related to duplicate/bundled servicesModifier | mixed

25	Significant, separately identifiable Evaluation and Management service by the same physician on the same day of the procedure or other service.
59	Distinct Procedural Service.
76	Repeat procedure by the same physician.
77	Repeat procedure by another physician.
62	Co-surgeons.
66	Surgical teams.
80	Assistant at surgery providing full assistance to the primary surgeon.
81	Assistant at surgery providing minimal assistance to the primary surgeon.
82	Assistant at surgery, when a qualified resident surgeon is not available.
91	Repeat clinical diagnostic laboratory test.

1–10 of 17

1/2

mixed

No codes listed

Billing Requirements and Provider Responsibilities

Billing Rule

Submit duplicate/subsequent services with appropriate modifier(s)

Submit duplicate or subsequent services with the appropriate modifier(s) that demonstrate the service was distinct, repeated, or otherwise billable; claims billed without the appropriate modifier(s) may be denied or recouped.

Use modifiers listed in the Related Coding section to indicate repeated or additional services.
Claims determined to be duplicate or subsequent without appropriate modifier(s) will be denied when billed on the same or separate claim.

Key Terms

inv-04: Duplicate Services

DefinitionA service is a definite duplicate when some or all of the following claim elements match: member; date of service; charge amount; provider of service/rendering provider; and type of service based on procedure or revenue codes.

Suspected duplicateA service is a suspected duplicate when the member and procedure code on the claim match.

Reimbursement conditionDuplicate services may be reimbursed only when billed with appropriate modifiers demonstrating the service is distinct or billable per policy and related modifier guidance.

Related materialsSee Code and Clinical Editing Guidelines; Modifier Usage; Modifiers 59, XE, XP, XS, XU; Modifiers 76, 77; Modifiers 80, 81, 82, AS; Modifier 91 for application details.

inv-05: Subsequent Service

DefinitionA subsequent service is a medically necessary service that is performed or provided for the same member more than once on the same date of service.

Reimbursement contextReimbursement for subsequent services is subject to correct modifier usage and applicable reimbursement rules as described in policy and related modifier guidance.

Documentation implicationProviders should document medical necessity and apply appropriate modifiers to support payment for repeated services on the same date of service.