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 | ||
| Apnea Monitors | This new policy provides industry-standard coding and billing information outlining modifiers, definitions, and associated medical policy. | July 27, 2026 |
| ECG Interpretation | This new policy provides industry-standard coding and billing information outlining modifiers, definitions, and associated medical policy. | July 27, 2026 |
| JW, JZ Drug dosing modifiers | This new policy provides industry-standard coding and billing information outlining modifiers, definitions, and associated medical policy. | July 27, 2026 |
| Medically Unlikely Edits | This new policy provides industry-standard coding and billing information outlining modifiers, definitions, and associated medical policy. | July 27, 2026 |
| Psychological and Neuropsychological Services | This new policy provides industry-standard coding and billing information outlining modifiers, definitions, and associated medical policy. | July 27, 2026 |
| Updated policies | ||
| Ambulatory surgical centers | The CMS website link has been added to the resources section, and Addendum EE is now included in the "Excluded from payment" list for Ambulatory Surgical Centers. | July 27, 2026 |
| Anesthesia services | A table listing payable and non-payable items has been added to the moderate sedation billing section. | July 27, 2026 |
| Chiropractic services | Revised terminology for secondary diagnosis. | July 27, 2026 |
| Evaluation and management | Information regarding modifiers 24 and 57 has been incorporated into the global surgical section. | July 27, 2026 |
| Flow cytometry | Flow cytometry details added to the definition. | July 27, 2026 |
| High tech radiology services | CPT codes 76014, 76015, 76016, and 76017 are not separately reimbursed on commercial claims. | July 27, 2026 |
| Maternity Services | The maternity care policy now states that, due to CPT code changes effective in 2027, prenatal care starting on or after June 1, 2026 will not use global maternity codes. All visits must be billed with appropriate E/M codes, the required TH modifier, and correct pregnancy-related diagnosis codes. | July 27, 2026 |
| Non-Invasive peripheral arterial vascular studies/ Non-Invasive Peripheral venous vascular & hemodialysis access studies | A coding specifics section was added with codes 93922–93926, 93930, and 93931 plus descriptions. Modifier details for 26 and TC were also included. | July 27, 2026 |