CommercialAdministrativeMedium impact
[New York] New combined reimbursement policy: Moderate (Conscious) Sedation — Professional and Facility
Anthem BCBS·NY · Anesthesiology, Gastroenterology, Pain Management +2 more·Claims & Billing
Effective date
Oct 1, 2026
We identified it
Sep 2, 2026
Summary
Effective October 1, 2026, Anthem Blue Cross and Blue Shield is consolidating its moderate (conscious) sedation reimbursement policies in New York by combining the existing separate professional reimbursement policy into a new unified policy covering both professional and facility components. Current professional reimbursement requirements remain unchanged; this is a policy consolidation, not a rate or coverage change. Balance billing members based on this change is prohibited.
Action Required
By September 30, 2026: Billing team must review the new combined Moderate (Conscious) Sedation — Professional and Facility reimbursement policy at the Anthem New York reimbursement policy page. Update internal billing references and documentation to reflect the retired separate professional policy and transition to the new combined policy. Ensure all staff understand that professional reimbursement requirements have not changed, only consolidated. Verify billing system configurations reflect the new policy structure to avoid claim denials. Confirm that no balance billing occurs related to this policy transition.