← Back to list
[New York] Reimbursement policy update: Moderate (Conscious) Sedation — Professional and Facility
Effective date
Feb 1, 2027
Identified
Nov 3, 2026
Summary
Effective February 1, 2027, Anthem will stop separately reimbursing moderate sedation services (revenue codes 0371 and 0372) on inpatient facility claims when reported with room and board charges for Commercial plans in New York and eight other states. Practices must stop billing these codes separately on inpatient UB-04 claims for Anthem members, as payment is now bundled into room and board reimbursement.
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
Action · 6 steps
01Before February 1, 2027.
02Update claim edits and charge entry logic to prevent revenue codes 0371 and 0372 from being billed separately on inpatient facility claims (UB-04) for Anthem Commercial members in New York, Georgia, Indiana, Kentucky, Missouri, Nevada, New Hampshire, Ohio, and Wisconsin.
03Tell billing staff and providers that moderate sedation services are now bundled into inpatient room and board reimbursement for these states and plans; claims without this change will be denied.
04Review current inpatient facility claims to identify any that report both revenue codes 0371/0372 and room and board charges, and prepare to resubmit corrected claims on or after February 1, 2027 if needed.
05Confirm that outpatient and non-room-and-board scenarios are unaffected and continue to bill as before.
06Document this change in your claim preparation workflow and billing procedures.
Original notice
[New York] Reimbursement policy update: Moderate (Conscious) Sedation — Professional and Facility
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[Ohio] Reimbursement policy update: Moderate (Conscious) Sedation — Professional and FacilityHighEffective Feb 1, 2027 · Claims & Billing[Georgia] Reimbursement policy update: Moderate (Conscious) Sedation — Professional and FacilityMediumEffective Feb 1, 2027 · Claims & BillingBrowse every Anthem BCBS change in the policy list