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[California] Include anatomical modifiers on outpatient facility claims
Act
by Dec 1, 2026
Effective date
Dec 1, 2026
Identified
Nov 3, 2026
Summary
Effective December 1, 2026, Anthem Blue Cross will require anatomical modifiers (E1–E4, FA, F1–F9, TA, T1–T9, LC, LD, LM, RC, RI, LT, RT, or 50) on outpatient facility claims when the CPT or HCPCS code specifies identification of the anatomical site. Claims without the required modifier or with a mismatched modifier will not be eligible for reimbursement.
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What to do
by Dec 1, 2026 · 4 steps
01Update charge entry and claim edits to ensure outpatient facility claims include the appropriate anatomical modifier (E1–E4 for eyelids, FA/F1–F9 for fingers, TA/T1–T9 for toes, LC/LD/LM/RC/RI for coronary arteries, LT for left side, RT for right side, or 50 for bilateral procedures) when the CPT or HCPCS code requires anatomical site identification.
02Tell providers and front desk staff to document the anatomical site (right, left, or bilateral) on encounter forms so billing can apply the correct modifier.
03Billing team should review existing outpatient facility charge templates and validate that modifiers will be populated correctly at claim submission.
04Watch for denials on claims processed on or after December 1, 2026 that lack required anatomical modifiers, and resubmit with the appropriate modifier if a claim is denied for missing or mismatched anatomy modifier.
Original notice
[California] Include anatomical modifiers on outpatient facility claims
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[New York] Include anatomical modifiers on outpatient facility claimsHighEffective Dec 1, 2026 · Provider Bulletin[Ohio] Include anatomical modifiers on outpatient facility claimsHighEffective Dec 1, 2026 · Provider Bulletin[Georgia] Include anatomical modifiers on outpatient facility claimsHighEffective Dec 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list