CurrentAnthemPolicy C-09005

Standby Services - Professional

Defines Anthem's reimbursement stance for professional standby and hospital-mandated on-call services for commercial members; affects professional providers submitting claims to Anthem in applicable jurisdictions.

Policy Summary

PayerAnthem

PolicyStandby Services - Professional

Policy CodePolicy C-09005

Change TypeNo material changes

Effective DateJul 20, 2022

Next Review Date

Key ActionEnsure services meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis; state and contract mandates take precedence.

SourceLink

POLICY UPDATE CHANGES

07/17/2024 review approved: no changes.

07/20/2022 review approved: minor language changes.

3Codes not eligible

2Codes eligible

2024Most recent review

Coverage criteria for standby and on-call services

Covered when ALL of the following are met:

Anthem does not allow reimbursement for standby or hospital-mandated on-call services unless provider, state, or federal contracts and/or mandates indicate otherwise.

Reimbursement is allowed for the specific service or procedure rendered by the provider following the standby period (the standby component itself is not separately reimbursed).

Standby services are nonreimbursable when the standby period ends with the provider rendering a specific procedure or service (the procedure may be reimbursed, but not the standby).

The prolonged attendance standby code (e.g., 99360) is not reimbursable in addition to initial evaluation and management codes for a normal newborn or delivery/birthing room resuscitation codes (e.g., 99460, 99465 are eligible but 99360 is not).

Policy Summary

PayerAnthem

PolicyStandby Services - Professional

Policy CodePolicy C-09005

Change TypeNo material changes

Effective DateJul 20, 2022

Next Review Date

Key ActionEnsure services meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis; state and contract mandates take precedence.

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 coding and reimbursement eligibility

Covered CPT CodesCPTCovered

99460	Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant.
99465	Delivery/birthing room resuscitation, provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output.

Not eligible for reimbursement CPT CodesCPTNot Covered

99026	Hospital mandated on call service; in-hospital, each hour.
99027	Hospital mandated on call service; out-of-hospital, each hour.
99360	Standby service, requiring prolonged attendance, each 30 minutes (eg, operative standby, standby for frozen section, for cesarean/high risk delivery, for monitoring EEG).

Authorization, medical necessity, and provider requirements

Prior Authorization

Prior authorization, medical necessity, billing, and documentation requirements

Services must meet Anthem authorization and medical necessity requirements and comply with any applicable state, federal or contract mandates; providers must bill using industry-standard CPT/HCPCS/revenue codes and support billed services in the medical record. Failure to follow appropriate authorization, medical necessity, coding, or billing guidelines may result in claim rejection, denial, or recovery/recoupment of payment.

Use CPT, HCPCS, and/or revenue codes that accurately reflect the service billed and ensure documentation in the medical record supports the billed codes.
Verify member benefit contract language and state/federal mandates first — those take precedence over this reimbursement policy.
Obtain any required prior authorization and ensure the service meets medical necessity for the procedure and diagnosis before billing.

OpenPayer

Standby Services - Professional

Coverage criteria for standby and on-call services

Related coding and reimbursement eligibility

Authorization, medical necessity, and provider requirements

Key definitions