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 |
|---|---|---|
| New policies | ||
| Blood Counts | This new policy provides industry-standard coding and billing information outlining modifiers, definitions, and associated medical policy. | June 16, 2026 |
| Updated policies | ||
| Always/Sometimes Therapy | This policy update includes added revenue code requirements for 042x, 043x, and 044x. | June 16, 2026 |
| Ambulance services | Priority Health will cover ambulance services that meet the ICD-10-CM and service level criteria listed on the CMS Ambulance fee schedule and MDHHS emergency transport diagnosis code database. | June 16, 2026 |
| Chiropractic Services | This policy update adds related service dx codes as secondary diagnoses; subluxation dx codes must be primary. | June 16, 2026 |
| Drugs Administered by Providers for FDA Approved or Medically Accepted Off Label Uses | This policy now features a National Drug Coding Reporting Section and excludes deleted code S0013. | June 16, 2026 |
| High Frequency Chest Wall Oscillation Devices | The requirements have been updated to specify that claims for 90-day or 3-month supplies must clearly indicate this information. | June 16, 2026 |
| Lab & Pathology | Diagnosis code combinations are now required for prostate-specific antigen codes, with a chart linked for reference. Frequency limits have been introduced for thyroid tests. Guidelines about the correct use of Modifier 91 have also been included. | June 16, 2026 |
| Maternity Services | The service name has been updated from "Maternity and Prenatal Care" to "Maternity Services." Modifiers 76 and 77 have been added to address same day services. Additionally, postpartum care guidelines now specify that postpartum services will be denied if a global code has already been billed. | N/A |