Anthem Blue Cross and Blue Shield HP
NYTransition: No separate transition date. Policy effective 2027-01-01
Commercial reimbursement policy C-19004, last approved 09/09/2026 and effective 01/01/2027, names In these same counties, Anthem Blue Cross and Blue Shield HP is the trade name of Anthem HP, LLC. Antepartum care must be reported per encounter with the applicable E/M code and modifier TH, up to 13 routine office or other outpatient visits per pregnancy episode under the same TIN. The first prenatal E/M visit must include an ICD-10-CM code from category Z3A. Labor management must be reported with CPT codes 59080–59083. Delivery must be reported with 59431, 59432, 59502, or 59503, plus a Z3A code. Postpartum care must be reported per encounter with the applicable E/M code and modifier TH, up to 3 routine visits within 12 weeks after delivery under the same TIN. Policy history adds a California and Virginia exemption effective TBD. This plan is Anthem HP, LLC in those New York counties, which that exemption does not name.
- Published
- 2026-09-09
- Transition starts
- No separate transition date. Policy effective 2027-01-01
- Billing starts
- January 1, 2027
- Evidence checked
- 2026-10-08
Billing notes and scope
- Codes affected
- 59080-59083, 59431, 59432, 59502, 59503
- Modifiers
- TH
- Global allowed through
- 2026-12-31
- Applies by
- Not published
- Product
- Commercial
- Source excerpt
- Labor management must be reported with CPT codes 59080–59083.
Scope: Commercial; Anthem HP, LLC, trade name Anthem Blue Cross and Blue Shield HP, in 17 southeastern New York counties
Transition: Policy history adds a California and Virginia exemption effective TBD. This plan is Anthem HP, LLC in those New York counties, which that exemption does not name.
Global billing: The policy replaces global obstetric reporting with per-encounter antepartum and postpartum E/M codes, labor-management codes 59080-59083, and delivery codes 59431, 59432, 59502, or 59503.
California and Virginia are the plans named in the exemption. This record does not apply that exemption here.
Example questions
How should I bill for Anthem Blue Cross and Blue Shield HP when itemized billing starts January 1, 2027 and global billing is allowed through December 31, 2026?
Can I still bill 59080-59083, 59431, 59432, 59502, 59503 for Anthem Blue Cross and Blue Shield HP after December 31, 2026? What replaces it?
Anthem Blue Cross and Blue Shield HP's guidance is 'Confirmed 2027 guidance'. What should I do for claims with DOS on or after Jan 1, 2027?