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[Georgia] New reimbursement policy: Modifiers 90, 91, and 92: Laboratory Services — Professional and Facility
Act
by Oct 15, 2026
Effective date
Nov 1, 2026
Identified
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.
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What to do
by Oct 15, 2026 · 7 steps
01Billing team must update billing system to DENY all claims billed with modifier 90 for laboratory services (except pathology provider claims).
02Update provider communication templates to clarify that performing providers must bill directly for laboratory tests—no pass-through billing allowed.
03Audit 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.
04For 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.
05Communicate 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.
06Failure to comply will result in claim denials and potential accounts receivable impact.
07Reference Anthem's Georgia reimbursement policy page for full policy details.
Codes mentioned
86701867028670387389G0432G0433
Original notice
[Georgia] New reimbursement policy: Modifiers 90, 91, and 92: Laboratory Services — Professional and Facility
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[Ohio] New reimbursement policy: Modifiers 90, 91, and 92: Laboratory Services — Professional and FacilityHighEffective Nov 1, 2026 · Claims & Billing[New York] New reimbursement policy: Modifiers 90, 91, and 92: Laboratory Services — Professional and FacilityHighEffective Nov 1, 2026 · Claims & Billing[California] New combined reimbursement policy: Modifiers 90 and 91: Laboratory ServicesHighEffective Dec 1, 2026 · Claims & Billing[California] New combined reimbursement policy: Modifiers 90 and 91: Laboratory ServicesHighEffective Dec 1, 2026 · Claims & BillingBrowse every Anthem BCBS change in the policy list