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Anthem BCBSMedicare Advantage · Billing Codes · Coding · NYHigh impact

[New York] Telehealth claims update: ICD-10-CM Excludes1 editing

Act
by Aug 31, 2026
Effective date
Sep 1, 2026
Identified
Jul 21, 2026

Summary

Beginning September 1, 2026, telehealth claims billed with Place of Service (POS) 02 or POS 10 will be subject to ICD-10-CM Excludes1 editing rules, the same as in-person claims. Claims submitted with diagnosis code combinations prohibited by Excludes1 notes may be denied for reimbursement. Providers must verify diagnosis codes do not violate Excludes1 conventions before submitting telehealth claims.

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What to do

by Aug 31, 2026 · 8 steps
01Billing team and clinical staff must implement verification procedures for all telehealth claims (POS 02 and POS 10) to ensure diagnosis code combinations comply with ICD-10-CM Excludes1 notes.
02Update billing system to apply Excludes1 editing rules to telehealth claims.
03Train providers and coders on Excludes1 conventions, using the example Z01.419 and Z12.4 as reference.
04Review current telehealth coding practices and identify common Excludes1 violations.
05Add Excludes1 compliance check to claim submission workflow in billing software.
06Document supporting medical records to justify selected diagnosis codes.
07Consequences: Claims with prohibited diagnosis code combinations will be denied for reimbursement.
08For disputed denials, submit appeals through Availity.com using the Provider Dispute Resolution Form with supporting documentation.

Codes mentioned

Z01.419Z12.4

Original notice

[New York] Telehealth claims update: ICD-10-CM Excludes1 editing
providernews.anthem.com · Always check the source before changing claims.
View original ↗

Related changes

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Related policy hubs

Anthem BCBS policiesNY policy changesCode Z01.419Code Z12.4

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