CommercialReimbursementMedium impact
[New York] PT and OT fee increase for Commercial products
Anthem BCBS·NY · Physical Therapy, Occupational Therapy·Provider Bulletin
Effective date
May 1, 2026
We identified it
May 18, 2026
Summary
Anthem Blue Cross and Blue Shield is increasing the per diem reimbursement rate for physical therapy (PT) and occupational therapy (OT) services under Commercial plans in New York from $75 to $85, effective May 1, 2026. This applies to HMO, EPO, PPO, Blue Access, Connection, and Indemnity products. Billing teams should update fee schedules and systems to reflect the new rate to avoid underbilling.
Action Required
Before May 1, 2026: Billing team must update all fee schedules in the billing system for Anthem Blue Cross and Blue Shield Commercial plans (HMO, EPO, PPO, Blue Access, Connection, and Indemnity) to reflect the new PT and OT per diem rate of $85 (increased from $75). Update rate tables in EMR/billing software, fee schedule documents, and superbill templates. Verify claims submitted on or after May 1, 2026 are billed at the new $85 rate. Claims billed at the old $75 rate after the effective date may result in underpayment.