CommercialReimbursementHigh impact
[California] Update to claims system: global surgical procedures
Anthem BCBS·CA · Ophthalmology, General Surgery·Provider Bulletin
Effective date
Mar 1, 2026
We identified it
May 7, 2026
Summary
Anthem Blue Cross is updating its claims editing system for global surgical procedures effective March 1, 2026. Claims for distinct surgical procedures performed during the postoperative period of a previous global surgical procedure will now be denied unless they use appropriate modifiers (58, 78, 79) or site modifiers, or have different diagnoses at the seventh digit level. Billing teams must implement system edits to review global period overlap and diagnosis codes to avoid claim denials.
Action Required
By February 28, 2026: Billing team must update claims system to implement automated edits that prevent reimbursement for procedures submitted during the postoperative period of a previous 10-day or 90-day global surgical procedure by the same provider for the same member unless: (1) modifier 58, 78, or 79 is present; (2) site modifiers (E1, E4, F1, F9, FA, T1, T9, TA, LM, RI, LC, LD, RC, RT, LT) are used; or (3) diagnosis codes differ at the seventh digit. Providers must be educated to append appropriate modifiers for distinct procedures performed during global periods. Update encounter documentation templates and billing workflows to capture modifier and diagnosis information accurately. Implement training for billing staff on global period rules. Verify system can compare diagnoses to the seventh digit level. Claims submitted without proper modifiers and matching diagnoses will be denied.