CurrentAnthemPolicy G-05006
Reimbursement Policy Consultations
Defines Anthem/Wellpoint reimbursement rules for face-to-face medical consultations by physicians or qualified nonphysician practitioners, including documentation, modifiers, preoperative/postoperative considerations, exclusions, and related coding guidance. Applies to specified Anthem/Wellpoint entities and Medicare Advantage in listed states.
Policy Summary
PayerAnthem
PolicyReimbursement Policy Consultations
Policy CodePolicy G-05006
Change TypeAdministrative clarifications and routine review
Effective Date12/02/2025
Next Review Date
Key ActionEnsure the attending provider's request, reason for consultation, consulting provider's written report (history, exam, findings, recommendations), and documentation of communication are present in the medical record to support reimbursement.
SourceLink
POLICY UPDATE CHANGES
12/19/2023 - Consultation in Definition section updated.
12/02/2025 - Review approved and effective: no changes.
G-05006Policy Number
12/02/2025Effective Date (current)
AZ, IA, NJ, SC, TN, TX, WA, WVExplicitly listed Anthem entities / jurisdictions
Face-to-faceCoverage modality requirement