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[Ohio] Include anatomical modifiers on outpatient facility claims
Effective date
Dec 1, 2026
Identified
Nov 3, 2026
Summary
Effective December 1, 2026, Anthem Blue Cross and Blue Shield in Ohio will require anatomical modifiers (such as LT/RT for laterality, E1–E4 for eyelids, FA/F1–F9 for fingers, TA/T1–T9 for toes, and coronary artery modifiers) on outpatient facility claims when CPT or HCPCS codes specify anatomical site identification. Claims missing required modifiers or with mismatched anatomical modifiers will not be eligible for reimbursement.
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What to do
Action · 5 steps
01Before December 1, 2026: Update charge entry and claim editing workflows to ensure anatomical modifiers are appended to CPT and HCPCS codes on outpatient facility claims when the code specifies laterality or anatomical site identification.
02The billing team must verify that required modifiers (LT, RT, 50, E1–E4, FA, F1–F9, TA, T1–T9, LC, LD, LM, RC, RI) are captured at the point of service and included on all outpatient facility claims submitted to Anthem Ohio.
03Instruct providers and front desk staff to document anatomical site (right, left, or bilateral) clearly on encounter forms and charge entry so modifiers are applied correctly before claim submission.
04After December 1, 2026, monitor claim denials for missing or incorrect anatomical modifiers and resubmit corrected claims with the appropriate modifier and supporting documentation.
05Do not balance-bill members for claim denials resulting from this modifier requirement.
Original notice
[Ohio] Include anatomical modifiers on outpatient facility claims
providernews.anthem.com · Always check the source before changing claims.
Related changes
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