Medicare AdvantageReimbursementHigh impact
[Virginia] New combined reimbursement policy: Modifiers 90 and 91: Laboratory Services
Anthem BCBS·VA · Pathology, Internal Medicine, Family Medicine +1 more·Claims & Billing
Effective date
Dec 1, 2026
We identified it
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.
Action Required
By November 30, 2026: Billing team must immediately cease submitting claims with modifier 90 for pass-through laboratory services to Anthem Medicare Advantage plans. Update billing software to block or flag modifier 90 submissions and route lab test claims for direct provider billing instead. Providers performing laboratory services must transition to direct billing models rather than pass-through arrangements. Conduct staff training on the modifier 90 prohibition and confirm modifier 91 billing practices remain unchanged for repeat lab tests. Update internal documentation and claim submission protocols to reflect the retirement of policy G-06020 and implementation of new policy G-20001. Failure to comply will result in claim denials and potential compliance violations. Ensure providers do not balance bill members for denied claims under this policy change.