CommercialBilling CodesHigh impact
[Georgia] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility
Anthem BCBS·GA, CT, IN, KY, MO, NV, NH, NY, OH, WI · Endocrinology, Family Medicine, General Practice +2 more·Claims & Billing
Effective date
Dec 1, 2026
We identified it
Sep 2, 2026
Summary
Effective December 1, 2026, Anthem will no longer reimburse medical nutritional therapy (CPT 97802–97804; HCPCS G0270–G0271) and obesity counseling services (HCPCS G0421, G0447) when billed on UB-04 (facility claims). These services are now eligible for reimbursement ONLY when submitted on CMS-1500 (professional claim form) by the rendering provider. Billing teams must immediately audit billing workflows to prevent claim denials and ensure correct claim form submission.
Action Required
By November 30, 2026: Billing team must implement the following: (1) Update billing software rules to block or flag submission of CPT codes 97802, 97803, 97804 and HCPCS codes G0270, G0271, G0421, G0447 on UB-04 claim forms; (2) Configure system to route these services exclusively to CMS-1500 professional claim submission; (3) Audit current workflows and encounter forms to identify any standing orders or templates that route these codes to UB-04; (4) Communicate change to all providers and facility staff who order or document nutritional therapy and obesity counseling services; (5) Train billing staff on new submission requirements. Failure to comply will result in claim denials for all affected codes submitted on UB-04 forms. Additionally, ensure participating providers understand the balance billing prohibition—they cannot bill members for denied claims due to this policy change.