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[Ohio] Observation service billing: review CMS requirements before
Effective date
Sep 1, 2026
Identified
Aug 3, 2026
Summary
Effective September 1, 2026, Anthem Blue Cross and Blue Shield in Ohio is updating observation service billing requirements to align with CMS guidance for claims billed under POS codes 19, 22, or 23. Key changes include: 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 bill appropriate outpatient service codes instead.
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What to do
Action · 7 steps
01Before September 1, 2026: Billing team must audit current observation service billing workflows and implement the following changes.
02Configure billing system to prevent submission of multiple initial observation service codes per patient visit.
03Establish a process to ensure only one observation service code is billed per calendar date per practitioner.
04Update provider education materials and encounter forms to clarify that only the physician ordering and overseeing observation care may bill observation codes—all other practitioners (consultants, additional evaluators) must use appropriate outpatient service codes instead.
05Train billing staff and providers on the new requirements to ensure compliant claim submission.
06Failure to comply will result in claim denials and potential overpayment recoupment.
07All staff should review this policy on Availity.com for claims submission and status tracking.
Original notice
[Ohio] Observation service billing: review CMS requirements before
providernews.anthem.com · Always check the source before changing claims.
Related changes
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