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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 Ohio Medicaid is implementing a new combined reimbursement policy (G-20001) that prohibits reimbursement for professional and outpatient facility claims billed with modifier 90 (pass-through laboratory billing). Providers performing tests must bill directly and will be reimbursed at 100% of the applicable fee schedule. The existing modifier 91 policy remains unchanged and continues to allow reimbursement for repeat clinical diagnostic laboratory tests at 100%.
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What to do
by Nov 30, 2026 · 6 steps
01Billing team must update all billing systems and encounter forms to prohibit the use of modifier 90 on laboratory claims for Anthem Ohio Medicaid (both professional and outpatient facility providers).
02Remove any logic that previously allowed pass-through billing with modifier 90.
03Train all billing and clinical staff on the new requirement.
04Ensure provider contracts and billing guidelines reflect that the performing laboratory must bill directly.
05Claims submitted with modifier 90 after December 1, 2026 will be denied.
06Modify 91 requires no changes and remains eligible for repeat laboratory test reimbursement at 100%.
Codes mentioned
9091
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
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