P F
Jul 1, 2025

Payment Policy Updates

Immunizations Adult and Pediatric Policy 

Effective July 1, 2025, there are five new codes that have been added to this policy:

90382, 90612, 90613, 90635, 91323

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

2025 Coding and Payment Guidelines Modifiers 

Effective July 1, 2025, modifiers PO and PN are required to be appended to services rendered for all off-campus institutional claim submissions (UB-04)

The following codes have been deleted effective June 30, 2025:

C9300, G9037, G9038, M0248

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

Non- Reimbursable Health Service Code Policy 2025 

Effective July 1, 2025, the following codes have been added to the NSR policy: 

0984T – NSR for Professional and Facility – Both Medicare and Commercial 

0985T – NSR for Professional and Facility – Both Medicare and Commercial

0986T – NSR for Professional and Facility – Both Medicare and Commercial

0987T – NSR for Professional and Facility – Both Medicare and Commercial

0961T – NSR for Professional and Facility – Both Medicare and Commercial

0962T – NSR for Professional and Facility – Both Medicare and Commercial

0973T – NSR for Professional and Facility – Both Medicare and Commercial

0974T – NSR for Professional and Facility – Both Medicare and Commercial

0975T – NSR for Professional and Facility – Both Medicare and Commercial

0976T – NSR for Professional and Facility – Both Medicare and Commercial

0964T – NSR for Professional and Facility – For Medicare Only

0965T – NSR for Professional and Facility – For Medicare Only

0966T – NSR for Professional and Facility – For Medicare Only

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

2025 Preventative Medicine and Other Evaluation and Management Office/Outpatient Services

Modifier 27 has been added to this policy to ensure clarity and to prevent any confusion regarding the appropriate use of modifier 27.

CPT Modifier 27 description: Multiple OP Hospital E/M encounters on the same date.  Commonly occurs when a member is seen in the ER and hospital outpatient dept on the same DOS. 

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