Treatment Rooms with Office Evaluation and Management Services - Facility
Defines Anthem's reimbursement requirements for reporting CPT/HCPCS codes with outpatient treatment room revenue codes and disallows reimbursement for office E/M services billed with revenue codes 760, 761, or 769. Applies to facility outpatient claims under Anthem commercial reimbursement policies.
Review approved and effective: no changes.
Added HCPCS code G0463 to Related Coding section.
Policy language updated to expand to revenue codes 760 and 769 when billed with office E/M codes; deny a facility claim line if revenue codes 760, 761 or 769 is not billed with an accompanying CPT or HCPCS code on a UB-04.
Initial approval and effective date recorded.
Treatment Room Revenue Code Billing Criteria
Treatment room revenue code billing criteria
Covered when ALL of the following are met:
ALL of the following
- The Health Plan requires the reporting of CPT® or HCPCS codes for treatment room revenue codes in an outpatient facility setting unless provider, state, federal contracts and/or mandate indicate otherwise.
- A CPT or HCPCS code must accompany revenue codes 760, 761, or 769 on a UB-04 or the facility claim line may be denied.
- The Health Plan does not allow reimbursement for office evaluation and management services when reported along with revenue codes 760, 761 or 769.
- There are no exemptions from this policy.
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.