← Back to list
[New York] 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
Anthem Medicare Advantage is implementing a new reimbursement policy effective December 1, 2026, that prohibits pass-through laboratory billing (modifier 90) for professional and outpatient facility providers, requiring them to bill directly instead. The existing modifier 91 guidance for repeat clinical diagnostic laboratory tests remains unchanged and has been consolidated into this new combined policy.
Get alerts when payers change rules like this one
We check Anthem BCBS and other payers every day and email you when a change matches your specialty and state.
Get Anthem BCBS alertsPolicy Monitoring is free. No card required.
What to do
by Nov 30, 2026 · 7 steps
01Billing team must audit all laboratory billing processes to eliminate use of modifier 90 on professional and outpatient facility claims submitted to Anthem Medicare Advantage.
02Update billing software to block or flag modifier 90 submissions for these claim types.
03Ensure all laboratory services are billed directly by the performing provider or facility rather than through pass-through billing arrangements.
04Confirm modifier 91 claims for repeat laboratory tests continue to be submitted at 100% of applicable fee schedule or contracted rate.
05Providers must be informed that balance billing members based on this policy change is prohibited.
06Failure to comply will result in claim denials for any modifier 90 billed claims on or after December 1, 2026.
07Exception: Pathology providers' use of modifier 90 is unaffected by this policy.
Original notice
[New York] 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 →[California] New combined reimbursement policy: Modifiers 90 and 91: Laboratory ServicesHighEffective Dec 1, 2026 · Claims & Billing[California] New combined reimbursement policy: Modifiers 90 and 91: Laboratory ServicesHighEffective Dec 1, 2026 · Claims & Billing[New York] New combined reimbursement policy: Modifiers 90 and 91: Laboratory ServicesHighEffective Dec 1, 2026 · Claims & Billing[Ohio] New combined reimbursement policy: Modifiers 90 and 91: Laboratory ServicesHighEffective Dec 1, 2026 · Claims & BillingBrowse every Anthem BCBS change in the policy list