New and updated billing policies are now available
We publish billing policies to offer transparency and help you:
- Bill claims more accurately
- Reduce delays in processing claims
- Avoid rebilling and additional requests for information
The following billing policies were recently published to or updated in our Provider Manual.
Note: If the effective date is listed as “N/A”, the policy represents our current system set up and expectations for transparency, represents no change for you and is already in effect.
| Policy | New or updated | Description | Effective date |
| Advanced Practice Professional (APP) | Updated | In alignment with CMS billing updates that went into effect on Dec. 1, 2024, we added billing requirements for APPs in multi-specialty groups, applicable to Medicare plans. | Dec. 1, 2024 (retroactive) |
| After Hours Weekend Care Professional | Updated | Added the place of service requirements for codes 99050 and 99051 for transparency into which settings are appropriate for these codes. | N/A |
| Excludes1 | New | This policy expands upon the Excludes1 billing information previously shared in our Provider Manual. It offers additional information and examples. There’s no change to how providers work with us now or how they’re reimbursed. | N/A |
| Inpatient and Outpatient Incidental Services and Supplies | Updated | Renamed the “Unbundling” policy and updated references throughout from “unbundling” to “incidental services and supplies”. | N/A |
| Nebulizers | New | This policy outlines frequency limits, coding and documentation requirements for nebulizers. Closely review the timing associated with appropriate billing for each code. | Apr. 21, 2025 |
| Urinary Tumor Markers for Bladder Cancer | New | This policy outlines frequency limits, coding and documentation requirements for bladder cancer tests. Closely review the timing associated with appropriate billing for these tests. | Apr. 21, 2025 |
| All policies | Updated | Added a "Disclaimer" section to all billing policies | N/A |