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Anthem BCBSCommercial · Billing Codes · Claims & Billing · NY, CT, GA, IN, KY, MO, NV, NH, OH · Sleep Medicine, PulmonologyHigh impact

[New York] Reimbursement policy update: Sleep Studies and Related Bundled Services and Supplies — Professional

Act
by Oct 31, 2026
Effective date
Nov 1, 2026
Identified
Aug 2, 2026

Summary

Effective November 1, 2026, Anthem is updating its sleep studies reimbursement policy to clarify that unattended and home sleep studies must be billed as professional services on CMS-1500 forms only. These services are NOT eligible for reimbursement when billed on UB-04 facility claim forms. This policy now applies to both professional and facility care providers in multiple states including New York.

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What to do

by Oct 31, 2026 · 6 steps
01Billing team must update all billing systems and workflows to ensure unattended and home sleep studies are ONLY billed on CMS-1500 professional claim forms, never on UB-04 facility forms.
02Update internal billing guidelines, provider documentation, and encounter forms to reflect this requirement.
03Train all billing staff on the new requirements.
04Verify that facility-based providers understand they cannot bill these services on facility claims.
05Failure to comply will result in claim denials and may trigger compliance violations.
06Confirm that providers are not balance-billing members based on this change.

Original notice

[New York] Reimbursement policy update: Sleep Studies and Related Bundled Services and Supplies — Professional
providernews.anthem.com · Always check the source before changing claims.
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Related changes

See all Anthem BCBS changes →
[Ohio] Reimbursement policy update: Sleep Studies and Related Bundled Services and Supplies — ProfessionalHighEffective Nov 1, 2026 · Claims & Billing[Georgia] Reimbursement policy update: Sleep Studies and Related Bundled Services and Supplies — ProfessionalHighEffective Nov 1, 2026 · Claims & BillingBrowse every Anthem BCBS change in the policy list

Related policy hubs

Anthem BCBS policiesNY policy changesCT policy changesGA policy changesIN policy changesKY policy changesMO policy changesNV policy changesNH policy changesOH policy changesSleep MedicinePulmonology

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