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[New York] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility
Act
by Sep 30, 2026
Effective date
Oct 1, 2026
Identified
Jul 2, 2026
Summary
Effective October 1, 2026, Anthem is requiring that professional services previously billed on UB-04 forms using revenue codes 0920, 0929, and 0942 must now be billed by the rendering provider on CMS-1500 claim forms using applicable HCPCS/CPT codes. Services billed on UB-04 with these revenue codes will no longer be reimbursed. This change affects billing practices only and does not change member care or services.
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What to do
by Sep 30, 2026 · 6 steps
01Billing team must audit current workflows to identify all claims using UB-04 forms with revenue codes 0920, 0929, or 0942.
02Update billing system and software to prevent submission of these revenue codes on UB-04 forms for Anthem commercial claims.
03Configure billing system to route these services to CMS-1500 claim forms instead, ensuring rendering providers bill using appropriate HCPCS/CPT codes.
04Educate rendering providers and clinical staff on the new requirement—services in these categories (diagnostic services, other diagnostic services, and therapeutic education/training) must be billed on CMS-1500 by the rendering provider, not on facility UB-04 forms.
05Update claim denial protocols to recognize and flag UB-04 submissions with codes 0920, 0929, 0942 for immediate correction before transmission.
06Coordinate with any hospital or facility partners to ensure they understand the change and do not bill these services on their UB-04 forms for Anthem.
If missed: Failure to comply will result in claim denials and loss of reimbursement for affected services.
Original notice
[New York] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[New York] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — FacilityHighEffective Dec 1, 2026 · Claims & Billing[Georgia] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — FacilityHighEffective Oct 1, 2026 · Claims & BillingBrowse every Anthem BCBS change in the policy list