MedicaidReimbursementHigh impact
[California] Prepare now for treatment room reimbursement updates
Anthem BCBS·CA·Claims & Billing
Effective date
Dec 1, 2026
We identified it
Aug 25, 2026
Summary
Effective December 1, 2026, Anthem Blue Cross Medi-Cal will no longer reimburse treatment room services (revenue codes 0760, 0761, 0769) as separate line items. These services must now be bundled and reimbursed as part of the main outpatient visit. Billing teams must review and update outpatient billing practices immediately to avoid claim denials and ensure compliant billing by the effective date.
Action Required
By November 1, 2026: Billing team must complete a comprehensive audit of current outpatient billing workflows to identify all claims using revenue codes 0760, 0761, or 0769. Update billing system edits and software validation rules to prevent standalone billing of these treatment room codes on or after December 1, 2026. Train all billing and coding staff on the bundling requirement and the specific scenarios where these codes should no longer be billed separately (E/M services, G0463 claims, and claims combined with ER, outpatient surgery, recovery room, observation, or clinic services). Remove any standing orders or billing templates that allow separate billing of treatment room codes. Test all system changes in staging environment before go-live on December 1, 2026. Communicate the change to all providers and front-office staff. Establish a monitoring process to identify and correct any non-compliant claims submitted after the effective date. Note: Members cannot be balance-billed as a result of this policy change.