Medicare AdvantageBilling CodesHigh impact
[California] Telehealth claims update: ICD-10-CM Excludes1 editing
Anthem BCBS·CA·Coding
Effective date
Sep 1, 2026
We identified it
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.
Action Required
By August 31, 2026: (1) Billing 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. (2) Providers must review current telehealth claim patterns to identify any diagnosis code combinations that violate Excludes1 notes and adjust coding documentation practices accordingly. (3) Update provider education materials and encounter form templates to include reminders about Excludes1 compliance for telehealth services. (4) Establish a process to verify diagnosis codes are coded to highest specificity with supporting documentation. Failure to comply will result in claim denials and loss of reimbursement for affected telehealth services. For disputes, use Availity.com or the Provider Dispute Resolution Form with supporting ICD-10-CM guidance and claim documentation.