April 2, 2026
The following policies received their annual review with no changes:
The following policies will be archived effective April 2, 2026:
The following policies received their annual review with the changes noted below:
- Added content from archived modifier 23 policy.
- From the exceptions section re-added Alaska lines of business as this was removed in error.
- Added to the policy section effective dates of service on and after July 3, 2026, rev codes 0760, 0769, and 0960 when billed with any evaluation and management (E&M) Current Procedural Terminology (CPT) codes 99201 to 99499 or Healthcare Common Procedure Coding System (HCPCS) clinic visit codes G0438, G0439, and G0463.
- Added clarifying statement to the policy section: “Modifier 57 should not be appended to an E&M service in the postoperative period when the decision for surgery is made to address complications resulting from the original surgery.”
- Changed the name from “Modifier 76-Repeat Procedure by The Same Provider” to “Modifier 76 and 77-Repeat Procedures.”
- Added content from archived modifier 77 policy.
- In the policy section, added a clarifying statement: “Failure to do so may result in denial of reimbursement,” within the paragraph for billing services on the same claim.
Multiple Diagnostic Imaging Reductions
- Added a clarifying statement to the policy section in the same session billing on a single claim paragraph: “Failure to do so may result in denial of reimbursement.”
Multiple Endoscopy Procedure Reductions
- Added a clarifying statement to the policy section: “All diagnostic imaging procedures rendered on the same date of service must be billed on the same claim. Failure to do so may result in denial of reimbursement.”
The following policies are new effective July 3, 2026:
Radiopharmaceuticals and Contrast Agents
- Effective dates of service on and after July 3, 2026, payment for diagnostic radiopharmaceuticals and contrast materials is considered inclusive to the major procedure performed. The Centers for Medicare & Medicaid Services (CMS) National Physician Fee Schedule (NPFS) has assigned most of these products with a status indicator “N” packaged service/item. No separate payment made.
Emergency Department Evaluation and Management Level of Service
- Effective for dates of service on and after July 3, 2026, the plan will review submitted claim information to determine the appropriate level of service that should be allowed for emergency department E&M services.
- Alaska lines of business and products are excluded.