All PlansBilling CodesMedium impact
[New York] Outpatient facility claims update: modifier 26 (professional services) on UB‑04
Anthem BCBS·NY·Provider Bulletin
We identified it
May 3, 2026
Summary
Anthem New York has updated their policy regarding modifier 26 (professional component) usage on UB-04 forms for outpatient facility claims. This affects how professional services are billed when provided in facility settings.
Action Required
Immediately: Review current billing practices for outpatient facility claims using modifier 26 on UB-04 forms. Billing team should verify proper application of modifier 26 for professional component services and update billing procedures as needed. Access the full policy details at the provided URL to understand specific requirements.