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Updated payment policies now available
January 8, 2026

This article is for all providers caring for our members

The following payment policies, updated in Q4 2025, are now available on Provider Central.

Payment policy Updates
Cardiology Services
  • Annual coding update; removed deleted codes 92921, 92925, 92929, 92934, 92938, 92944, 92977
Clinical Trials
  • Updated template
COVID-19 temporary payment policy
  • Annual coding update; revised code descriptor for 90480
CPT and HCPCS Modifiers
  • Annual coding update; updated modifier 59 code pairs list
Evaluation and Management
  • Annual coding update; revised descriptor for code G0136
Expanded Molecular Panel Testing of Cancers
  • Annual coding update; revised code descriptor for 0569U
General Coding and Billing
  • Annual coding update; updated Category III range to 1025T; updated measurement codes M range to M1503
  • Updated link to modifier 59 code pairs
Inpatient Acute Medical Admission
  • Added readmission exclusion guidelines when the readmission is for a transplant APR-DRG effective for discharge dates on or after January 1, 2026
Laboratory and Pathology
  • Annual coding update; removed deleted code 55700
Non-Reimbursable Services
  • Updated non-reimbursed list links for professional providers and facility providers
Outpatient Rehabilitation Services - Facility
  • Annual review; updated template
  • Edited to clarify general benefit information to say certain services may require notification, referral, or authorization
PT/OT- Independent Practice
  • Annual coding update; added new RTM codes 98984-98985, 98979 and revised descriptors for codes 98976-98977, 98980-98981
  • Edited to clarify general benefit information to say certain services may require notification, referral, or authorization
  • Removed referral and notification language from PT and OT sections under specific billing guidelines
Radiology – Multiple Imaging
  • Annual coding update; added new 2026 codes 70471, 70473
Radiation Oncology
  • Annual coding update; removed deleted codes 77014, 77385-77386, 77401, G6012-G6015
  • Added new codes 77436-77439 effective January 1, 2026
Serious Reportable Events
  • Updated template
  • Updated to include instructions on split billing, Hospital Acquired Conditions, and inclusion of professional services
Telehealth (Telemedicine) – Medical Services
  • Updated list of face-to-face medical services eligible to be performed via telehealth and/or telephone & reimbursable telephonic and telehealth services
Telehealth (Telemedicine) – Mental Health
  • Updated list of face-to-face medical services eligible to be performed via telehealth and/or telephone & reimbursable telephonic and telehealth services

Download our payment policies.

To download our payment policies, log in and click Find a Payment Policy on the right side of your home page. Or, go to Office Resources>Policies & Guidelines>Payment Policies.

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