CommercialBilling CodesHigh impact
[New York] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility
Anthem BCBS·CT, GA, IN, KY, MO, NV, NH, NY, OH, WI · Endocrinology, Bariatric Surgery, Family 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 claim forms. These services are only reimbursable when submitted by the rendering provider on CMS-1500 professional claim forms using the applicable codes. Participating providers cannot balance bill members for this change.
Action Required
By November 30, 2026: Billing team must update claim submission workflows to route outpatient medical nutritional therapy (CPT 97802–97804; HCPCS G0270–G0271) and obesity counseling (HCPCS G0421, G0447) claims to CMS-1500 professional forms only—NOT UB-04 facility forms for Anthem Commercial plans. Update billing system edits and rules to prevent UB-04 submissions for these codes. Audit templates and encounter forms to ensure providers understand the claim form requirement. Train billing staff on the new routing. Notify providers that Anthem will deny any of these services submitted on UB-04 effective December 1, 2026. Do not balance bill members; absorb denials as a result of this policy change.