CommercialBilling CodesHigh impact
[Ohio] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility
Anthem BCBS·OH, CT, GA, IN, KY, MO, NV, NH, NY, WI · Endocrinology, Bariatric Surgery, Internal Medicine +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 outpatient 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 by the rendering provider on CMS-1500 (professional claim form). Billing teams must route these services to the correct claim form type to avoid denials.
Action Required
By November 30, 2026: Billing team must implement system changes to prevent these codes (97802, 97803, 97804, G0270, G0271, G0421, G0447) from being submitted on UB-04 facility claims for Anthem Commercial plans in affected states. Route all medical nutritional therapy and obesity counseling services to CMS-1500 professional claim forms only. Update billing software edits and encounter forms to enforce this requirement. Train providers and billing staff on the new routing rule. Document this change in internal billing procedures. Failure to submit on correct claim form will result in claim denials and member balance billing is prohibited.