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[Ohio] 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 Blue Cross and Blue Shield Medicare Advantage in Ohio is implementing a new reimbursement policy that prohibits pass-through laboratory billing using modifier 90—the performing provider must bill directly for reimbursement at 100% of the applicable fee schedule. Modifier 91 guidance remains unchanged and eligible for reimbursement on repeat clinical diagnostic laboratory tests. The existing modifier 91 policy (G-06020) will be retired and consolidated into the new combined policy (G-20001).
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What to do
by Nov 30, 2026 · 5 steps
01Billing team must audit all laboratory service claims currently using modifier 90 to identify pass-through billing scenarios and implement workflow changes to prevent submission of modifier 90 claims.
02Update billing system edits to block modifier 90 on professional and outpatient facility claims (with exception for pathology provider claims).
03Train providers and billing staff that performing providers must bill laboratory services directly without modifier 90.
04Verify that modifier 91 claims for repeat clinical diagnostic laboratory tests continue to be submitted correctly.
05Audit claims submitted after December 1, 2026 to ensure compliance.
If missed: Failure to comply will result in claim denials and potential overpayment recovery.
Original notice
[Ohio] 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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