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[Virginia] 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
Anthem Medicare Advantage is implementing a new combined reimbursement policy (G-20001) effective December 1, 2026, that prohibits pass-through laboratory billing with modifier 90 on professional and outpatient facility claims—these claims will no longer be reimbursed. Providers performing lab tests must bill directly. Modifier 91 guidance for repeat clinical diagnostic laboratory tests remains unchanged and eligible for reimbursement. The previous modifier 91 policy (G-06020) will be retired.
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What to do
by Nov 30, 2026 · 7 steps
01Billing team must immediately cease submitting claims with modifier 90 for pass-through laboratory services to Anthem Medicare Advantage plans.
02Update billing software to block or flag modifier 90 submissions and route lab test claims for direct provider billing instead.
03Providers performing laboratory services must transition to direct billing models rather than pass-through arrangements.
04Conduct staff training on the modifier 90 prohibition and confirm modifier 91 billing practices remain unchanged for repeat lab tests.
05Update internal documentation and claim submission protocols to reflect the retirement of policy G-06020 and implementation of new policy G-20001.
06Failure to comply will result in claim denials and potential compliance violations.
07Ensure providers do not balance bill members for denied claims under this policy change.
Codes mentioned
9091
Original notice
[Virginia] New combined reimbursement policy: Modifiers 90 and 91: Laboratory Services
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[Virginia] September 2026 Provider NewsletterHighNo effective date · Newsletter[Ohio] September 2026 Provider NewsletterHighNo effective date · Newsletter[New York] September 2026 Provider NewsletterHighNo effective date · Newsletter[California] September 2026 Provider NewsletterHighNo effective date · NewsletterBrowse every Anthem BCBS change in the policy list