We publish billing policies to promote transparency and help providers submit more accurate claims, reducing processing delays, rebilling and requests for additional information. New policies and updates to existing policies are shared monthly.
Note: If the effective date is listed as N/A, the policy represents our current system set up and/or expectations for transparency. There are either no changes for you as the policy is already in effect or was recently shared with the network, and we’re implementing a clinical edit in alignment with the policy language.
The following billing policies were recently published to or updated in our Provider Manual.
| Billing policy | Description | Effective date |
|---|---|---|
| New policies | ||
| Charge master policy (#206) | These new policies provide industry-standard coding and billing information, outlining modifiers, definitions and associated medical policies. | Oct. 20, 2026 |
| Nutrition counseling, education and therapy (#204) | ||
| Robotically Assisted Surgery(#205) | ||
| Updated policies | ||
| Cardiovascular Disease Risk Assessment(#132) | We’ve added code G0537 and removed any coverage-related content, as well as the information outlining non-covered screenings and diagnosis codes. | Aug. 20, 2026 |
| Cervical Fusion (#148) | We’ve revised policy links and location information, and added applicable CPT codes and their descriptions. | |
| Durable Medical Equipment (DME) Capped Rental (#110) | We’ve added modifier BP and definitions and updated the KJ modifier. | |
| Helicobacter Pylori (H. Pylori) Testing (#151) | We’ve added the medical policy link. | |
| Osteogenesis (#104) | We’ve deleted all medical necessity and coverage information. | |
| Tumor Treatment Field Therapy (TTFT) (174) | We’ve added definitions for the various pulmonary function tests (PFTs) to enhance clarity. | |
| Nerve Blocks for Peripheral Nerve Neuropathy (#146) | We’ve added language indicating that Priority Health aligns with criteria from the Centers for Medicare and Medicaid Services (CMS) for services and conditions that don’t meet medical necessity requirements. | Oct. 20, 2026 |
| Scanning computerized ophthalmic diagnostic imaging (SCODI) (#030) | We’ve added language indicating that Priority Health aligns with criteria from the Centers for Medicare and Medicaid Services (CMS) for services and conditions that don’t meet medical necessity requirements. | |
As a reminder, providers should refer to policy #84 for drugs administered by providers for FDA-approved or medically accepted off-label uses.