2026 Home Health Care Services - Skilled Services
This policy was updated to reflect that service revenue codes 042X, 043X, or 044X must include the appropriate therapy service modifier appended to the CPT code. Specifically, providers should append modifier GP for physical therapy, GO for occupational therapy, or GN for speech-language pathology services, as applicable.
Claims submitted with one of these revenue codes and a modifier is missing, or the wrong required therapy modifier is appended for dates of service on or after October 1, 2026 will be denied.
For additional details related to this policy, please click here.
2026 Behavioral Health Integration Services including the Collaborative Care Model
Effective October 1, 2026 this policy was updated to identify which provider types are/are not eligible to be reimbursed for the collaborative care codes identified in this policy.
The provider specialties listed below are not eligible for reimbursement for the codes identified in this policy under the Collaborative Care benefit:
• Psychiatrists (MD, DO)
• Psychiatric Neurologist (MD, DO)
• Child/Adolescent Psychiatrist (MD, DO)
• Clinical Nurse Specialist (CNS)
• Behavioral Health Nurse Practitioner (BH NP)
• Behavioral Health Physician’s Assistant (BH PA)
• Psychologists (PhD, PsyD)
• Licensed Independent Clinical Social Workers (LICSW)
• Licensed Mental Health Counselors (LMHC)
• Licensed Marriage and Family Therapists (LMFT)
• Licensed Behavior Analysts (LBA)
• Licensed Chemical Dependency Professionals (LCDP)
For additional details related to this policy, please click here.
Pharmacy Post Claim Review Medications
As part of the monthly review. This policies drug list was updated.
For additional details related to this policy, please click here.
2026 Early Intervention Services
This policy was updated to reflect that not all services quality as preventative depending on the member’s plan; member cost-share may apply if the member has a high-deductible health plan.
For additional details related to this policy, please click here.