CommercialBilling CodesHigh impact
[New York] Reimbursement policy update: Sleep Studies and Related Bundled Services and Supplies — Professional
Anthem BCBS·NY, CT, GA, IN, KY, MO, NV, NH, OH · Sleep Medicine, Pulmonology·Claims & Billing
Effective date
Nov 1, 2026
We identified it
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.
Action Required
By October 31, 2026: Billing 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. Update internal billing guidelines, provider documentation, and encounter forms to reflect this requirement. Train all billing staff on the new requirements. Verify that facility-based providers understand they cannot bill these services on facility claims. Failure to comply will result in claim denials and may trigger compliance violations. Confirm that providers are not balance-billing members based on this change.