Immunizations Adult and Pediatric Policy
Effective 1 de julho, 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 1 de julho, 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 30 de junho, 2025:
C9300, G9037, G9038, M0248
For additional details related to this policy, please click here.
Non- Reimbursable Health Service Code Policy 2025
Effective 1 de julho, 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.