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[California] New combined reimbursement policy: Modifiers 90 and 91: Laboratory Services
Act
by Nov 15, 2026
Effective date
Dec 1, 2026
Identified
Sep 2, 2026
Summary
Anthem Blue Cross is implementing a new combined reimbursement policy for laboratory service modifiers 90 and 91, effective December 1, 2026. Modifier 90 (pass-through laboratory billing) is now NON-REIMBURSABLE for professional and outpatient facility providers—the performing provider must bill directly for 100% reimbursement. Modifier 91 (repeat clinical diagnostic lab tests) remains eligible for reimbursement at 100% on professional claims. The existing modifier 91 policy (G-06020) will be retired.
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What to do
by Nov 15, 2026 · 8 steps
01Billing team must update billing software and internal procedures to implement modifier 90 denial logic for Anthem Blue Cross Medicare Advantage claims in California.
02Configure system to automatically deny or reject any claims billed with modifier 90 by professional or outpatient facility providers.
03Update provider communication templates to instruct providers that modifier 90 is not reimbursable and they must bill directly as the performing provider.
04Retain existing modifier 91 reimbursement rules in billing system (no changes needed).
05Train billing staff to identify and route modifier 90 claims for denial before submission.
06Remove references to retired policy G-06020.
07Audit existing denied claims with modifier 90 to identify potential appeal opportunities for dates of service on or after December 1, 2026.
08Communicate policy change to in-network providers and facility partners in California.
If missed: Failure to implement will result in claim denials and provider billing disputes.
Original notice
[California] 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[New York] 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