Elevance Health announced a series of new billing policies intended to more closely align reimbursement with the physical location where services are furnished. The policies will apply across the company’s commercial, Medicare Advantage, and Medicaid lines of business and will be phased in during 2026 and 2027.
Under the new approach, hospitals will be required to identify the physical location where care was delivered. Elevance will compare billing information with hospital location data and, for certain services furnished at off-campus hospital locations, apply the applicable off-campus payment rate. The policies also are intended to prevent higher hospital-based reimbursement for certain laboratory services performed at a different location.
The changes are part of a broader movement toward greater site-of-service transparency and site-neutral payment. Federal and state policymakers have increasingly focused on payment differences between hospital outpatient departments and physician offices when similar services are furnished in both settings.
GI Impact: The policies may be particularly relevant for gastroenterology practices affiliated with health systems, hospital-owned clinics, outpatient departments, and laboratory services. GI practices should monitor Elevance implementation guidance closely, including any changes to place-of-service reporting, claim submission requirements, facility reimbursement, and payment for services furnished at off-campus locations.
The announcement also signals continued payer interest in using site-of-care information to address payment differentials, an issue likely to remain important for GI practices as both public and private payers pursue broader site-neutral payment policies.