CommercialBilling CodesHigh impact
[Ohio] Reimbursement policy update: Sleep Studies and Related Bundled Services and Supplies — Professional
Anthem BCBS·OH · Sleep Medicine, Pulmonology·Claims & Billing
Effective date
Nov 1, 2026
We identified it
Aug 3, 2026
Summary
Effective November 1, 2026, Anthem Blue Cross and Blue Shield is changing how unattended and/or home sleep studies must be billed in Ohio. These services must now be billed on CMS-1500 professional claim forms only and are NOT eligible for reimbursement when billed on UB-04 facility claim forms. This is a critical billing requirement change that affects claim submission method and provider credentialing.
Action Required
By October 31, 2026: Billing team must implement the following changes for all Anthem commercial claims in Ohio: (1) Update billing system to route unattended and home sleep study claims to CMS-1500 professional claim forms ONLY—block any attempts to submit on UB-04 facility forms; (2) Update provider training materials and billing workflows to clarify that home/unattended sleep studies are professional services, not facility services; (3) Audit current sleep study billing patterns to identify any claims incorrectly submitted on UB-04 forms and contact Anthem for guidance on resubmission; (4) Update encounter forms and superbills to designate home/unattended sleep studies as professional services; (5) Communicate policy change to all sleep medicine providers and facility partners in Ohio to prevent billing errors. CONSEQUENCES: Claims submitted on UB-04 forms will be denied for reimbursement. Providers are prohibited from balance-billing members for this policy change.