Payment Policy Updates

September 4, 2025

The following policies received their annual review with no changes:

• Add-On Codes
• Group Psychotherapy Services (90853)
• Medically Unlikely Edits (MUEs)/Maximum Units of Service
• Modifier 25 – Significant, Separately Identifiable Evaluation & Management (E&M) Service on Same Day of Procedure or Other Service
• Modifier 58 - Staged or Related Procedure or Service by Same Physician or Other Qualified Healthcare Professional during Postoperative Period
• Modifier 54, 55, 56 - Surgical Care Only/Postoperative Management Only/Preoperative Management Only
• Modifier 91 – Repeat Clinical Diagnostic Laboratory Test
• Teledentistry Services

The following policies received their annual review with the changes noted below:

Drug and Biologic Edits for Drugs Administered in a Physician Office or in an Outpatient Facility Clinic

• Revised Policy Title to include Outpatient Facility Clinic
• Revised the Policy statement to now include D&B edits being applied to drugs and medications billed on a facility claim, effective with claim dates of service on and after December 5, 2025.