CommercialCoverageHigh impact
[Ohio] Reimbursement policy update: Screening Services with Related Evaluation and Management Services — Professional
Anthem BCBS·OH · Family Medicine, Internal Medicine, OB-GYN +2 more·Claims & Billing
Effective date
Apr 1, 2026
We identified it
May 12, 2026
Summary
Effective April 1, 2026, Anthem will update its reimbursement policy to clarify that screening services, annual gynecological exams, counseling, medical nutrition therapy, prolonged services, and visual acuity screenings cannot be billed separately when provided on the same day as preventive medicine visits (CPT 99381-99387, 99391-99397, G0402). Modifier 25 appending will not override this bundling restriction. The policy will be renamed to reflect preventive medicine services focus.
Action Required
By March 31, 2026: Billing team must update billing system rules to prevent separate reimbursement for the following services when billed on the same date of service as preventive medicine codes (99381-99387, 99391-99397, G0402): annual gynecological exams, counseling services, medical nutrition therapy, other E/M services, prolonged services, screening services, and visual function/acuity screenings. Remove or deactivate any billing logic that allows Modifier 25 to bypass this bundling restriction for Anthem Ohio commercial plans. Audit pending and open claims for dates of service on or after April 1, 2026 to identify and correct unbundled claims. Train providers and front-desk staff that these services are included in the preventive visit and cannot be billed separately. Failure to implement these changes will result in claim denials and payment recoupments from Anthem.