We publish billing policies to offer transparency and help providers to bill claims more accurately to reduce delays in processing claims, as well as avoid rebilling and additional requests for information.
The following billing policies were recently published to or updated in our Provider Manual.
Be sure to review carefully. Some policy updates will be effective Dec. 14, 2026, due to new requirements or changes that may impact how you work with us.
All other policies represent our current system set up and/or expectations for transparency. There are either no changes for providers as the policy is already in effect or the policy was recently shared with the network and we’re implementing a clinical edit in alignment with the policy’s language.
| Billing policy | Description | Effective date |
|---|
| New policies |
| Autopsy Billing - #210 | - New billing policies created based on information found in the Priority Health Provider Manual
| N/A |
| Urology Billing - #208 |
| Ventricular Assist Devices - #209 |
| Updated policies |
| Cardiology - #003 | - Added the Policy Overview section
- Added new guidance for Transcatheter Aortic Valve Replacement (TAVR) under the Valve Replacement section to enhance policy clarity and support accurate billing and coding practices
| N/A |
| Facility Billing - #005 | - Added Policy Overview and Definitions sections
- Revising policy-specific tables
- Updated Accommodation Condition Codes
- Removed obsolete condition code categories
- Added facility billing code reference tables (Discharge Codes, Occurrence & Value Codes, TOB and Admission Source)
- Updated the References and Disclaimer sections
| N/A |
| Infusion Services Supplies - #041 | - Added a Policy Overview section
- Updated the Definitions section for greater clarity
- Updated the Policy Specific Information section to clarify that disposable delivery systems are considered non-covered under the policy
| Dec. 14, 2026 |
| Medical Errors: Serious Reportable Events / Hospital Acquired Conditions - #172 | - Renamed the Definitions section to Policy Overview
- Reorganized Coding Specifics
- Added applicable CPT codes and a Modifier table
| N/A |
| Non-Invasive Cerebrovascular Studies - #169 | - Added Policy Overview, Definitions, Coding Specifics, Place of Service and Modifiers sections to improve organization, clarify policy requirements and provide more comprehensive billing and coding guidance
| N/A |
| Pelvic and Transvaginal Ultrasound - #056 | - Added Policy Overview and Definitions sections
- Added applicable CPT codes into the Coding Specifics section
- Added Modifier 59 to the Modifiers section
- Added to the Coding Specifics section that CPT codes 76801, 76856 and 76857 will be denied when billed with 76817 or 76830, due to overlapping ultrasound services
| Dec. 14, 2026 |
| Pressure Reducing Support Surfaces - #161 | - Updated the Policy Overview and Coding Specifics sections to reflect current policy guidance and coding requirements
- Removed coverage criteria
| N/A |
| Radiation Oncology - #027 | - Added CPT code 77301 (IMRT planning) and related bundling guidance
- Added a Modifier section with billing guidelines and a Provider Manual reference
- Added a Place of Service section outlining medical necessity and authorization requirements
| N/A |