CommercialReimbursementHigh impact
[Georgia] New reimbursement policy: Modifiers 90, 91, and 92: Laboratory Services — Professional and Facility
Anthem BCBS·CT, GA, IN, MO, NV, NH, NY, OH, WI · Pathology·Claims & Billing
Effective date
Nov 1, 2026
We identified it
Aug 3, 2026
Summary
Effective November 1, 2026, Anthem is implementing new reimbursement guidance for laboratory service modifiers 90, 91, and 92. Modifier 90 (pass-through laboratory billing) will no longer be reimbursed—the performing provider must bill directly. Modifiers 91 and 92 guidance remains unchanged but is being consolidated into a single policy. Billing teams must immediately audit claims and update systems to prevent denials for modifier 90 usage.
Action Required
By October 15, 2026: (1) Billing team must update billing system to DENY all claims billed with modifier 90 for laboratory services (except pathology provider claims). (2) Update provider communication templates to clarify that performing providers must bill directly for laboratory tests—no pass-through billing allowed. (3) Audit recent claims (past 6 months) billed with modifier 90 to identify patterns and prepare rebill strategy for dates of service on/after Nov 1, 2026. (4) For modifier 92, restrict reimbursement in billing software to ONLY codes 86701, 86702, 86703, 87389, G0432, and G0433 on professional claims; deny all other lab codes with modifier 92. (5) Communicate to all in-house providers and contracted laboratories that pass-through billing (modifier 90) is no longer permitted; direct billing by performing provider is required. Failure to comply will result in claim denials and potential accounts receivable impact. Reference Anthem's Georgia reimbursement policy page for full policy details.