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[Georgia] New combined reimbursement policy: Modifiers 90 and 91: Laboratory Services
Act
by Nov 30, 2026
Effective date
Dec 1, 2026
Identified
Sep 2, 2026
Summary
Effective December 1, 2026, Anthem Medicare Advantage is implementing a new combined reimbursement policy (G-20001) that prohibits reimbursement for laboratory services billed with modifier 90 (pass-through billing). Providers must bill directly for laboratory services and will be reimbursed at 100% of the applicable fee schedule. The existing modifier 91 guidance for repeat clinical diagnostic laboratory tests remains unchanged and is consolidated into this new policy. The prior modifier 91 policy (G-06020) is being retired.
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What to do
by Nov 30, 2026 · 7 steps
01Billing team must implement the following changes for all Anthem Medicare Advantage claims in affected states.
02Stop billing laboratory services with modifier 90 immediately—these claims will be denied.
03Update billing software and encounter forms to flag any modifier 90 laboratory claims for rejection before submission.
04Retrain billing staff and providers that laboratory services must be billed directly by the performing provider or facility, not as pass-through (modifier 90) claims.
05Confirm modifier 91 procedures for repeat clinical diagnostic laboratory tests are still eligible for reimbursement at 100% and remain in billing workflows.
06Retire all references to policy G-06020 in internal documentation and replace with policy G-20001.
07Note: Pathology services billed with modifier 90 are excluded from this restriction.
If missed: Failure to comply will result in claim denials for all modifier 90 laboratory services.
Original notice
[Georgia] New combined reimbursement policy: Modifiers 90 and 91: Laboratory Services
providernews.anthem.com · Always check the source before changing claims.
Related changes
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