← Back to list
[California] Observation service billing: review CMS requirements before
Effective date
Sep 1, 2026
Identified
Aug 2, 2026
Summary
Effective September 1, 2026, Anthem Blue Cross (Medicare Advantage) is updating observation service billing requirements to align with CMS guidance for claims billed under POS codes 19, 22, or 23. Key changes: only one initial observation service code per patient visit, only one observation code per calendar date per billing practitioner, and only the ordering/overseeing physician may bill observation codes—other practitioners must use appropriate outpatient service codes instead.
Get alerts when payers change rules like this one
We check Anthem BCBS and other payers every day and email you when a change matches your specialty and state.
Get Anthem BCBS alertsPolicy Monitoring is free. No card required.
What to do
Action · 8 steps
01Before September 1, 2026: Billing team must implement the following changes.
02Update billing system validation rules to prevent submission of multiple initial observation service codes per patient visit or multiple observation codes per calendar date per practitioner.
03Audit current observation service billing practices to identify which practitioners are billing these codes and ensure only ordering/overseeing physicians bill observation services.
04Train clinical and billing staff that consultants and other practitioners during observation stays must bill appropriate outpatient service codes instead of observation codes.
05Review and update encounter forms/templates to clarify billing practitioner requirements.
06Configure system edits to enforce one observation code per date per billing practitioner.
07Failure to comply will result in claim denials and potential compliance issues with Anthem.
08Verify all claims submitted on or after September 1, 2026 conform to these requirements.
Original notice
[California] Observation service billing: review CMS requirements before
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[Georgia] Observation service billing: review CMS requirements beforeHighEffective Sep 1, 2026 · Claims & Billing[Ohio] Observation service billing: review CMS requirements beforeHighEffective Sep 1, 2026 · Claims & Billing[Virginia] Observation service billing: review CMS requirements beforeHighEffective Sep 1, 2026 · Claims & Billing[New York] Observation service billing: review CMS requirements beforeHighEffective Sep 1, 2026 · Claims & BillingBrowse every Anthem BCBS change in the policy list