CommercialReimbursementHigh impact
[Georgia] Reimbursement policy update: Screening Services with Related Evaluation and Management Services — Professional
Anthem BCBS·GA, CT, IN, KY, MO, NV, NH, NY, OH, WI · Family Medicine, Internal Medicine, OB-GYN +2 more·Claims & Billing
Effective date
Apr 1, 2026
We identified it
May 3, 2026
Summary
Effective April 1, 2026, Anthem Georgia updates its preventive medicine reimbursement policy to prohibit separate billing of screening services, counseling, medical nutrition therapy, prolonged services, visual acuity screenings, gynecological exams, and other E/M services when billed on the same day as a preventive medicine visit (CPT 99381-99387, 99391-99397, G0402). Modifier 25 will not override this bundling restriction. The policy is renamed to reflect this scope.
Action Required
By March 15, 2026: Billing team must update billing software and claim submission rules to prevent separate reimbursement of screening services, counseling, medical nutrition therapy, prolonged services, visual acuity screenings, and other E/M services when billed on the same date as CPT codes 99381-99387, 99391-99397, or G0402. Remove Modifier 25 override logic for Anthem Georgia claims, as it will not result in separate payment. Update provider encounter templates and superbill instructions to communicate bundling requirements. Train billing and clinical staff that these services must be included as part of the preventive medicine visit without separate line items. Failure to comply will result in claim denials and requests for refunds on improperly billed services.