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[New York] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility
Act
by Nov 30, 2026
Effective date
Dec 1, 2026
Identified
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.
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What to do
by Nov 30, 2026 · 6 steps
01Billing 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.
02Update billing system edits and rules to prevent UB-04 submissions for these codes.
03Audit templates and encounter forms to ensure providers understand the claim form requirement.
04Train billing staff on the new routing.
05Notify providers that Anthem will deny any of these services submitted on UB-04 effective December 1, 2026.
06Do not balance bill members; absorb denials as a result of this policy change.
Codes mentioned
978029780397804G0270G0271G0421G0447
Original notice
[New York] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[Ohio] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — FacilityHighEffective Dec 1, 2026 · Claims & Billing[Georgia] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — FacilityHighEffective Dec 1, 2026 · Claims & Billing[Virginia] Payment discontinued for select procedure codes effectiveHighEffective Jan 1, 2027 · Claims & Billing[New York] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — FacilityHighEffective Oct 1, 2026 · Claims & BillingBrowse every Anthem BCBS change in the policy list
Related policy hubs
Anthem BCBS policiesCT policy changesGA policy changesIN policy changesKY policy changesMO policy changesNV policy changesNH policy changesNY policy changesOH policy changesWI policy changesEndocrinologyBariatric SurgeryFamily MedicineInternal MedicineGeneral PracticeCode 97802Code 97803Code 97804Code G0270Code G0271Code G0421Code G0447