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 | ||
| Lab: Special histochemical stains and immunohistochemical stains | This policy provides general coding guidance on documentation, modifiers and POS information | NA |
| MDS FISH | This policy outlines billing criteria | NA |
| Mechanical in-exsufflation devices | This policy outlines billing criteria | NA |
| Methylmalonic acid testing | This policy outlines billing criteria | NA |
| Non-invasive cerebrovascular studies | This policy outlines billing criteria | NA |
| Telemedicine | We're retiring this medical policy | Jan. 13, 2026 |
| Updated policies | ||
| Provider-based billing | We're updating this policy to include modifier CG to override edit when providers are within 250 yards of a hospital | Jan. 13, 2026 |
| High-level E/M with preventive | This update includes clarification that this policy applies to Medicare since it doesn't have it's own policy. CPE codes are not covered by Medicare | NA |