We publish billing policies to offer transparency and help you 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’s Billing Policies page.
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’s language.
| Billing policy | Description | Effective date |
| Bowel management devices | This new policy outlines billing guidelines for the Peristeen Bowel Management Device. | Nov. 17, 2025 |
| Category III CPT codes | This new policy offers billing guidelines for category III CPT codes. Refer to the applicable medical policy for coding guidelines as many services are not covered or require authorization. | N/A |
| Cervical cancer screening | This new billing policy was created using information from the Provider Manual’s preventive services section . | N/A |
| Cervical fusion | The new policy outlines billing guidelines for CPT codes between 63075 and 22554. | Nov. 17, 2025 |
| Critical care services | Updated to remove the following statement: Medical records can be submitted via appeal if extenuating circumstances exist for a same-day discharge of a member who received critical care services | N/A |
| Diagnosis of vaginitis | This new policy includes billing guidelines for diagnosis of vaginitis. | N/A |
| Endoscopic treatment of GERD | This new policy offers guidance for two services for the endoscopic treatment of Gastroesophageal Reflux Disease (GERD). | N/A |
| Facet joint interventions for pain management | This new billing policy outlines billing guidelines for facet joint interventions for pain management. | N/A |
| Fundus photography | Updated to add diagnoses diagnosis H31.091-H31.093 | N/A |
| Gynecologic surgery | This new policy currently includes billing guidelines for uterine fibroid treatment but will be expanded in the future to include additional service types. | N/A |
| Helibactor Pylori testing | This new policy outlines billing guidelines for the H pylori test, noting that members 18 and older can have this test when criteria are met. | Nov. 17, 2025 |
| Maternity and prenatal care | Updated to add information on diagnosis sequencing | Nov. 17, 2025 |
| Miscellaneous durable medical equipment (DME) | Updated hearing aid battery limits based on MDHHS guidelines | Oct. 1, 2025 |
| Nerve blocks for peripheral neuropathy | This new policy outlines billing guidelines for nerve blocks. | N/A |
| Non-invasive abdominal / visceral vascular studies | This new policy outlines billing guidelines for non-invasive abdominal/visceral vascular studies. | Nov. 17, 2025 |
| Parental and enteral nutrition | This new policy outlines billing guidelines for parental and enteral nutrition. | N/A |
| Polysomnography and sleep studies | Updated to add:
| N/A |
| Prosthetic orthotics and footwear | Updated to add billing guidelines for facial prosthesis, ocular prosthesis and the AV modifier | Nov. 17, 2025 |
| Radiation oncology | Updated to clarify when 77338 should be billed | N/A |
| Removal of benign skin lesions | Updated to add information on frequencies and modifier 57 | Nov. 17, 2025 |
| Surgical treatment and oral appliances for sleep apnea: obstructive and central | This new billing policy was created using information from the Provider Manual. | N/A |
| Varicose vein treatments | This new policy outlines billing guidelines for varicose vein treatment. | Nov. 17, 2025 |