COVID-19 Monoclonal Antibody Treatment and Antiviral IV Medications

This policy was updated to correct outdated and expired CPT Codes for coverage of drugs/admins of monoclonal antibodies. Terminated pharmacists from charging E&M service when prescribing monoclonal antibody Rx. Since the ending of the PHE, this service has been out of their scope of practice. For additional details related to this policy, please click here.

Bundled Professional Services 

This new policy is effective October 1, 2025.  The purpose of this policy is to define payment criteria for services and supplies that are ineligible for separate reimbursement when reported by professional Physician and Non-physician Practitioner providers when filed on a professional claim.(1500).

This policy provides a description and the code pair relationship for procedures that are not eligible for separate reimbursement when performed with another specific service or supply.  This policy follows CMS Correct Coding Initiative (CCI), and Medicare (CMS) guidelines.

The bundling list of codes for example, Column one is not paid when billed with code from 

column 2.  Modifiers cannot override these edits.  For additional details related to this policy, please click here.

2025 Non-Reimbursable Health Service Codes Policy

This policy was updated to remove CPT Code 89258 - Cryopreservation; Embryo(s) from the professional listing effective January 1, 2025. For additional details related to this policy, please click here.

Acupuncture and Dry Needling Services for Medicare Advantage 

This policy was updated to reflect the 2026 changes to the individual Medicare Advantage products. Effective January 1, 2026, individual Medicare Advantage is no longer covering non-Medicare acupuncture services, and only Chronic Lower Back Pain. For additional details related to this policy, please click here.

Preventive Services for Commercial

CPT Code 92552 “hearing test” - pure tone audiometry, air only was added to this policy to process as a preventive benefit. 

CPT Code 87389 immunoassay testing; (for ex: HIV) was added to this policy to process as a preventative benefit. 

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

2025 Lactation Consultations

This policy was updated to reflect the incorrect information reflected back in September. CPT code 98960 is not limit to one unit, and is unlimited.

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

Coding and Payment Guidelines /  Modifiers

This policy was updated to include modifier Q0 (zero). 

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

Timely Filing Limit

We updated this policy to remind providers to submit appeals via the provider portal, fax, or email as we are trying to step back from paper appeals. 

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