Anthem Blue Cross in California does not list a clear policy for PCM services, which is why claims are often denied as “no fee schedule.” Since they sometimes pay after a pricing appeal, the best solution is to continue submitting appeals with supporting documentation, as coverage can vary by case. Some insurers, like Cigna, also do not cover these codes consistently, so it is possible that Anthem has limited or no coverage. Just like
merino wool is valued differently depending on quality and source, PCM services may be handled differently by each insurer, so confirming directly with Anthem and keeping records of appeal outcomes is the most reliable approach.
