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 | ||
| Assistant at Surgery – Modifiers 80/81/82 and AS (#191) | This new policy provides industry-standard coding and billing information outlining modifiers, definitions and associated medical policy. | Aug. 25, 2026 |
| Code Modifiers (#196) | ||
| Cosmetic & Reconstructive Surgery (#197) | ||
| Custodial Care (#185) | ||
| Diabetes Prevention Program (#193) | ||
| Human Chorionic Gonadotropin (#194) | ||
| Infrared Therapy (#195) | ||
| Updated policies | ||
| Arthrocentesis Aspiration Injection (#048) | We’ve added a section for related denial language, noting that the U54 procedure code requires an anatomical modifier. | Aug. 25, 2026 |
| Balloon Sinus Ostial Dilation for Chronic Sinusitis and Eustachian Tube Dilation (#119) | We’ve removed the age requirement for this policy in alignment with changes made to the Balloon Sinus Ostial Dilation for Chronic Sinusitis and Eustachian Tube Dilation medical policy to support consistency and clarity across Priority Health policies. | |
| Behavioral Health (#054) | We’ve added mental health screening information and a modifier table. Modifiers with an * will be denied if a global code was already billed for this service. | |
| Inpatient and Outpatient Incidental Services and Supplies (#013) | We’ve added clarification on billing for surgical dressings provided in a physician’s office (POS 11). These are considered part of the global surgical service and will be denied if submitted separately. Per CMS policy, they’re incident to the professional service and not independently reimbursable. | |
| Medicare Annual Wellness Visit/ Preventive Care Visits (#064) | We’ve updated criteria for the following billing codes:
These codes can now only be billed once every 12 months, rather than the previous guideline of once in a calendar year. | |
| Prosthetics, Orthotics and Footwear (#051) | We’ve added the CG modifier to our list of approved modifiers for this service. | |
| Clinical Edits (#192) | This policy's content was pulled from a pre-existing Provider Manual page. | N/A |
| Maternity services (#071) | We’ve added additional information on E/M coding to the Maternity Care Policy Update section in alignment with American Medical Association (AMA) guidelines. Note: This is a correction to our April billing policies update for Maternity Services to reflect new guidance shared by the American Medical Association (AMA) on E/M coding and TH modifiers. | N/A |
| Partial Hospitalization Program (PHP) (#045) | We’ve added a bill-type table. | N/A |