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Anthem BCBSMedicare Advantage · Billing Codes · Coding · CAHigh impact

[California] 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, Anthem Blue Cross will apply ICD-10-CM Excludes1 editing rules to telehealth claims billed with Place of Service (POS) 02 or POS 10, matching the standards already applied to other claim types. Telehealth claims with diagnosis code combinations prohibited by Excludes1 notes may be denied for reimbursement. Providers must verify diagnosis code combinations comply with Excludes1 conventions before submitting telehealth claims.

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What to do

by Aug 31, 2026 · 6 steps
01Billing team must update telehealth claim submission workflows to include validation of ICD-10-CM Excludes1 rules for POS 02 and POS 10 claims in billing software or manual review processes.
02Providers must review current telehealth claim patterns to identify any diagnosis code combinations that violate Excludes1 notes and adjust coding documentation practices accordingly.
03Update provider education materials and encounter form templates to include reminders about Excludes1 compliance for telehealth services.
04Establish a process to verify diagnosis codes are coded to highest specificity with supporting documentation.
05Failure to comply will result in claim denials and loss of reimbursement for affected telehealth services.
06For disputes, use Availity.com or the Provider Dispute Resolution Form with supporting ICD-10-CM guidance and claim documentation.

Codes mentioned

Z01.419Z12.4

Original notice

[California] 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 policiesCA policy changesCode Z01.419Code Z12.4

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