CommercialReimbursementHigh impact
[Ohio] New reimbursement policy: Modifiers 90, 91, and 92: Laboratory Services — Professional and Facility
Anthem BCBS·OH · Pathology·Claims & Billing
Effective date
Nov 1, 2026
We identified it
Aug 3, 2026
Summary
Anthem is implementing a new reimbursement policy for laboratory service modifiers effective November 1, 2026. Modifier 90 (pass-through laboratory billing) will no longer be reimbursed—providers must bill directly for lab services. Modifiers 91 and 92 retain existing guidance (91 for repeat tests, 92 for specific codes only). This affects how labs bill for services but does not change member benefits.
Action Required
By October 31, 2026: (1) Billing team must update billing software to REJECT claims billed with modifier 90 and route them back to providers instructing them to bill directly without pass-through modifier. (2) Educate all lab and facility providers that modifier 90 is no longer reimbursable effective 11/1/26—providers performing tests must bill directly at 100% of fee schedule/contracted rate. (3) Verify modifier 91 (repeat lab tests) and modifier 92 (limited to codes 86701, 86702, 86703, 87389, G0432, G0433 on professional claims only) rules are correctly configured in billing system—these are unchanged but consolidating into new policy. (4) Add internal workflow notes that pathology services with modifier 90 ARE excluded from the non-reimbursement rule and remain eligible. (5) Confirm staff understand no balance billing is permitted to members due to this change. Failure to implement will result in claim denials for modifier 90 billed services.