Effective August 15, 2026, this policy is to ensure appropriate billing and reimbursement for device intensive procedures performed in the outpatient facility setting. Device intensive procedures generally require the implantation, insertion, replacement, or utilization of a costly medical device integral to the performance of the procedure.

This policy relates to claims denying for a device intensive procedure when a corresponding device procedure code is not billed on the same claim for the same date of service, by the same provider, unless an applicable modifier indicates a reduced, discontinued, or terminated procedure.

This policy applies to facility claims only, outpatient institutional claims, claims billed on a UB-04 or electronic equivalent - Providers submitting bill types 13X or 76X

This policy does not apply to: professional claims, Physician office claims, inpatient facility claims, and claims outside the identified bill types

For additional details related to this new policy, please click here.