Treatment Rooms - Facility
Defines Anthem's reimbursement policy for reporting and reimbursing treatment room revenue codes in outpatient facility settings; applies to facility providers submitting claims to Anthem commercial plans, with specific state exceptions noted.
Added language to not allow reimbursement for revenue code 0760, 0761, and 0769 when billed with Emergency Room (045X), Outpatient Surgery (036X), Recovery Room (071X), Observation (0762), and Clinic (051X).
Added Wisconsin exemption allowing revenue code 0760/0761/0769 when billed with Clinic (051X) or Freestanding Clinic (052X).
Updated title from Treatment rooms with Office Evaluation and Management Services and added language for new or established patient and consultation.
Treatment Room Reimbursement Criteria
Treatment room revenue code reimbursement criteria
Covered when the following reporting and billing requirements are met; exceptions and state-specific rules apply.
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.