View payment policy updates archive
August 6, 2026
The following policies received their annual review with no changes:
The following policies received their annual review with the changes noted below:
- Added to the exceptions section: “Critical Care services (CPT 99291, 99292) for multiple providers from the same group and specialty may be reported on separate claims.”
Contract Exclusions/Disallowed Charges – Inpatient and Outpatient Facility Services
- Added cross reference policy: Intraoperative Neurophysiologic Monitoring (IONM) Billing
- To the policy section, added:
- Under the nursing care and treatment inclusive section: venipuncture (effective for dates of service on or after November 6, 2026).
- Drains and surgical tubing to operating room/surgical suite services.
- Clarified the facility personnel services section.
- IONM to the facility personnel services section (effective for dates of service on or after November 6, 2026).
Evaluation and Management (E&M) Visit Billed with Preventive Medicine Examination
- Changed the title name from “Evaluation and Management (E&M) Visit Billed with Preventive Medicine Examination” to “Office or Home Visit Billed with Preventive Examination.”
- Clarified verbiage in the policy section.
Facility Fees: Clinic Services, Professional Fees and Specialty Services-Treatment Room
- Removed Alaska lines of business from the exceptions section effective for dates of service on and after November 6, 2026.
- In the policy section, new coding details for the global maternity changes effective September 1, 2026, and January 1, 2027.
- Added a statement to utilize existing criteria for dates of service prior to January 1, 2027.
- Moved all code details to the coding section.
- Clarified details for labor management, antepartum care, and postpartum care.
- Reorganized the content to fit within specific categories for maternity care.
- In the coding section, termed global maternity and delivery codes.
- Added new delivery and labor management codes to the coding section effective January 1, 2026.
- Added transition code details for antepartum care starting September 1, 2026.
- In the exceptions section, added: “Effective dates of service on and after November 6, 2026, reimbursement will change from 13% to 10% of the Alaska provider’s applicable fee schedule allowed amount for the primary surgery.”
Modifier 54, 55, 56 - Surgical Care Only/Postoperative Management Only/Preoperative Management Only
- In the policy section, clarified verbiage under each modifier what provider type applies.
- Added statements in the policy section:
- “Used to report different tests such as species, strains, specimens, sites, toxins, antibodies, etc. reported by the same code. Please refer to the Modifier 59 - Distinct Procedural Service policy.”
- “Documentation in the medical record must indicate the need to repeat the same identical procedure or service as the original reported procedure or service.”