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[Virginia] Payment discontinued for select procedure codes effective
Act
by Jan 1, 2027
Effective date
Jan 1, 2027
Identified
Nov 4, 2026
Summary
Effective January 1, 2027, HealthKeepers, Inc. (Anthem HealthKeepers Plus Medicaid in Virginia) will discontinue reimbursement for 44 specific procedure codes to align with the Virginia Department of Medical Assistance Services (DMAS) fee schedule. The practice must stop billing these codes for dates of service on or after that date, as claims for discontinued codes will be denied or subject to adjustment and recovery.
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What to do
by Jan 1, 2027 · 7 steps
01Billing team must update charge entry and claim edits to prevent submission of the 44 discontinued codes for HealthKeepers, Inc.
02Anthem HealthKeepers Plus Medicaid members in Virginia for dates of service on or after January 1, 2027.
03Billing team must review the current DMAS fee schedule at https://www.dmas.virginia.gov/for-providers/rates-and-rate-setting/procedure-fee-files-cpt-codes/ to confirm coverage and billing requirements for affected codes and identify any alternative codes or services that remain covered.
04Billing team must communicate the code discontinuation to providers and front desk staff, instructing them to stop scheduling or rendering these services for this plan in Virginia, or to confirm with patients that the service is no longer covered by this plan effective January 1, 2027.
05If any of these codes were commonly billed, audit recent claims submitted to HealthKeepers, Inc.
06for these codes with service dates on or after January 1, 2027 and be prepared to resubmit corrected claims without the discontinued codes or appeal denials if claims were already processed.
07Consequence: Claims submitted with discontinued codes will be denied, adjusted, recovered, or subject to other corrective action.
Codes mentioned
G221190868G0444G0545G0439G0447G028399402S908398960G221290867G0442G043890482H003399358G0426365917556598962G0425G0268G042787812G0446G6015S0285G0407G0475G04229947090483S9460
Original notice
[Virginia] Payment discontinued for select procedure codes effective
providernews.anthem.com · Always check the source before changing claims.
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