CurrentBlue Cross Blue Shield - MainePolicy N/A

Behavioral health outpatient services not reimbursable on UB-04

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Governs reimbursement stance requiring professional behavioral health services to be billed on professional claim forms (CMS-1500/837P) rather than UB-04 institutional forms for affected Blue Cross Blue Shield - Maine / Anthem commercial plans, effective October 15, 2026.

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyBehavioral health outpatient services not reimbursable on UB-04

Policy CodePolicy N/A

Change TypeBilling format requirement (revised)

Effective DateOct 15, 202623d

Next Review DateN/A

Key ActionDo not submit professional behavioral health services on UB-04; submit on CMS-1500/837P unless contracts or mandates dictate otherwise.

SourceLink

POLICY UPDATE CHANGES

Anthem will not allow reimbursement for professional behavioral health services when billed on a UB-04 claim form unless provider, state, and federal contracts and/or mandates indicate otherwise.

Oct 15, 2026policy effective date for claim format change

10+revenue codes not reimbursable on UB-04

CMS-1500/837Pmandated claim form

No balance billingmember billing protection

Coverage Criteria

Billing format exclusion for UB-04

Behavioral health outpatient services listed by revenue code are not reimbursable on UB-04 institutional claim forms and must be billed on professional claim forms except where provider, state, or federal contracts or mandates provide otherwise.

Anthem will not allow reimbursement for professional behavioral health services when billed on a UB-04 claim form unless provider, state, and federal contracts and/or mandates indicate otherwise.

Professional behavioral health services must be billed on a professional claim form (CMS-1500/837P).

Affected revenue codes: The following revenue codes are not reimbursable on a UB-04 and must be billed on CMS-1500/837P when billing professional behavioral health outpatient services: 0900, 0902, 0903, 0904, 0911, 0914, 0915, 0916, 0917, 0918, 0919, 0953.

Participating care providers are prohibited from balance billing members based on this policy change.

Effective for dates of service on or after October 15, 2026; providers should submit professional behavioral health services on CMS-1500/837P unless contracts or mandates require UB-04 submission.

Coding and Claim Form Requirements

Revenue codes not reimbursable on UB-04RevenueNot Covered

0900	Behavioral Health Treatments/Services - General
0902	Behavioral Health Treatments/Services - Milieu therapy
0903	Behavioral Health Treatments/Services - Play therapy
0904	Behavioral Health Treatments/Services - Activity therapy
0911	Behavioral Health Treatments/Services - Rehabilitation
0914	Behavioral Health Treatments/Services - Individual therapy
0915	Behavioral Health Treatments/Services - Group therapy
0916	Behavioral Health Treatments/Services - Family therapy
0917	Behavioral Health Treatments/Services - Biofeedback
0918	Behavioral Health Treatments/Services - Testing

1–10 of 12

1/2

Claim form requirement

Required claim formProfessional behavioral health services must be billed on the CMS-1500/837P professional claim form.

UB-04 submissionsClaims for professional behavioral health services submitted on a UB-04 will not be reimbursed unless provider, state, or federal contracts and/or mandates require otherwise.

Effective dateRequirement effective for dates of service on or after October 15, 2026.

PurposeSupports standardized claims submission, accurate claims processing, and appropriate reimbursement of professional behavioral health services.

Balance-billing protectionParticipating care providers are prohibited from balance billing members based on this policy change.

Provider Actions and Billing Rules

Billing Rule

Bill professional behavioral health services on CMS-1500/837P (not UB-04)

Do not submit professional behavioral health services on a UB-04 institutional claim form; bill these services on a professional claim form (CMS-1500/837P) unless provider, state, or federal contracts or mandates require otherwise.

Effective for dates of service on or after October 15, 2026, Anthem will not allow reimbursement for professional behavioral health services when billed on a UB-04 unless contracts/mandates indicate otherwise.
Participating care providers are prohibited from balance billing members based on this policy change.

Definitions

CMS-1500/837P (Professional claim form)

TermCMS-1500/837P

DefinitionProfessional claim form used to bill professional behavioral health services.

Required useAnthem requires professional behavioral health services to be submitted on this form to ensure standardized processing and reimbursement.

UB-04 (Institutional claim form)

TermUB-04

DefinitionInstitutional claim form; behavioral health outpatient revenue codes listed in this policy are not reimbursable on UB-04 for professional services unless contracts/mandates indicate otherwise.

Policy stanceAnthem will not allow reimbursement for professional behavioral health services when billed on a UB-04 except where provider, state, or federal contracts and/or mandates require otherwise.

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyBehavioral health outpatient services not reimbursable on UB-04

Policy CodePolicy N/A

Change TypeBilling format requirement (revised)

Effective DateOct 15, 202623d

Next Review DateN/A

Key ActionDo not submit professional behavioral health services on UB-04; submit on CMS-1500/837P unless contracts or mandates dictate otherwise.

SourceLink

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Behavioral health outpatient services not reimbursable on UB-04

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Sign up for all Blue Cross Blue Shield - Maine policy alerts

Know when Blue Cross Blue Shield - Maine releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Coverage Criteria

Billing format exclusion for UB-04

Anthem will not allow reimbursement for professional behavioral health services when billed on a UB-04 claim form unless provider, state, and federal contracts and/or mandates indicate otherwise.

Professional behavioral health services must be billed on a professional claim form (CMS-1500/837P).

Participating care providers are prohibited from balance billing members based on this policy change.

Effective for dates of service on or after October 15, 2026; providers should submit professional behavioral health services on CMS-1500/837P unless contracts or mandates require UB-04 submission.

Coding and Claim Form Requirements

Revenue codes not reimbursable on UB-04RevenueNot Covered

0900	Behavioral Health Treatments/Services - General
0902	Behavioral Health Treatments/Services - Milieu therapy
0903	Behavioral Health Treatments/Services - Play therapy
0904	Behavioral Health Treatments/Services - Activity therapy
0911	Behavioral Health Treatments/Services - Rehabilitation
0914	Behavioral Health Treatments/Services - Individual therapy
0915	Behavioral Health Treatments/Services - Group therapy
0916	Behavioral Health Treatments/Services - Family therapy
0917	Behavioral Health Treatments/Services - Biofeedback
0918	Behavioral Health Treatments/Services - Testing

1–10 of 12

1/2

Claim form requirement

Required claim formProfessional behavioral health services must be billed on the CMS-1500/837P professional claim form.

UB-04 submissionsClaims for professional behavioral health services submitted on a UB-04 will not be reimbursed unless provider, state, or federal contracts and/or mandates require otherwise.

Effective dateRequirement effective for dates of service on or after October 15, 2026.

PurposeSupports standardized claims submission, accurate claims processing, and appropriate reimbursement of professional behavioral health services.

Balance-billing protectionParticipating care providers are prohibited from balance billing members based on this policy change.

Provider Actions and Billing Rules

Billing Rule

Bill professional behavioral health services on CMS-1500/837P (not UB-04)

Effective for dates of service on or after October 15, 2026, Anthem will not allow reimbursement for professional behavioral health services when billed on a UB-04 unless contracts/mandates indicate otherwise.
Participating care providers are prohibited from balance billing members based on this policy change.

Definitions

CMS-1500/837P (Professional claim form)

TermCMS-1500/837P

DefinitionProfessional claim form used to bill professional behavioral health services.

Required useAnthem requires professional behavioral health services to be submitted on this form to ensure standardized processing and reimbursement.

UB-04 (Institutional claim form)

TermUB-04