CommercialAdministrativeHigh impact
[Georgia] Reimbursement policy update: Sleep Studies and Related Bundled Services and Supplies — Professional
Anthem BCBS·GA, CT, IN, KY, MO, NV, NH, NY, OH · Sleep Medicine, Pulmonology·Claims & Billing
Effective date
Nov 1, 2026
We identified it
Aug 3, 2026
Summary
Effective November 1, 2026, Anthem Blue Cross and Blue Shield is changing how unattended and home sleep studies must be billed. These services must now be billed as professional services on CMS-1500 forms only—they are no longer eligible for reimbursement when billed on UB-04 facility claim forms. Billing teams must ensure sleep study claims are submitted on the correct form type or face denial.
Action Required
By October 31, 2026: Billing team must implement the following changes for all Anthem Blue Cross and Blue Shield commercial plans in Georgia and applicable states: (1) Update billing software to route unattended and home sleep study claims exclusively to CMS-1500 professional claim forms; (2) Remove or disable the ability to bill sleep studies on UB-04 facility forms for these payers; (3) Train all billing and coding staff on the new form requirements; (4) Update billing guides and internal documentation; (5) Audit any pending sleep study claims to ensure correct form type is used. Audit claims submitted 30 days prior to effective date to identify any that were billed incorrectly on UB-04 forms and consider resubmission on CMS-1500. Failure to comply will result in claim denials. Providers are prohibited from balance-billing members due to this policy change.