CommercialReimbursementHigh impact
[Georgia] Outpatient facility claims update: modifier 26 (professional services) on UB‑04
Anthem BCBS·GA·Provider Bulletin
Effective date
Apr 1, 2026
We identified it
May 3, 2026
Summary
Effective April 1, 2026, Anthem will no longer allow separate facility reimbursement for outpatient facility claim lines with modifier 26 (professional services). This aligns with Anthem's Facility Guidelines for Claims Related to Professional Services. Billing teams must stop expecting dual reimbursement (facility + professional) on modifier 26 claims and prepare for potential claim denials or adjustments.
Action Required
By March 31, 2026: Billing team must audit all outpatient facility claims currently using modifier 26 to identify affected procedures and revenue streams. Update billing software to prevent submission of modifier 26 on UB-04 forms for separate facility reimbursement, or implement internal edits to flag these claims for manual review. Notify providers and facility coders that modifier 26 claims will no longer generate dual facility payments. Establish a process to appeal any claims denied under this new rule using Anthem's claim dispute process. Document the policy change in compliance training and update billing workflows accordingly. Failure to adjust billing practices may result in claim denials, payment adjustments, or overpayment recovery demands.