Aug. 25, 2025
Clinical Payment and Coding Policies describe payment rules and methodologies for Current Procedural Terminology (CPT®) codes, Healthcare Common Procedure Coding System and ICD-10 coding for claims submitted as covered services. This information is a resource for our payment policies. It’s not intended to address all reimbursement-related issues. We regularly add and modify clinical payment and coding policy positions as part of our ongoing policy review process.
The following policies were updated:
- CPCP004 Neonatal Intensive Care Unit Level of Care Authorization and Reimbursement Policy, effective Aug. 25, 2025
- CPCPLAB035 Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease, effective Oct. 1, 2025
- CPCPLAB037 Serum Tumor Markers for Malignancies, effective Oct. 1, 2025
- CPCPLAB044 Lyme Disease Testing, effective Oct. 1, 2025
- CPCPLAB045 Pathogen Panel Testing, effective Oct. 1, 2025
- CPCPLAB070 Prescription Medication and Illicit Drug Testing in the Outpatient Setting, effective Oct. 1, 2025
- CPCP022 Pneumatic Compression Devices, effective Oct. 31, 2025
- CPCP023 Modifier Reference Policy, effective Oct. 31, 2025
- CPCPLAB015 Hepatitis Testing, effective Nov. 7, 2025
- CPCPLAB020 Cardiovascular Disease Risk Assessment, effective Nov. 7, 2025
- CPCPLAB037 Serum Tumor Markers for Malignancies, effective Nov. 7, 2025
- CPCPLAB045 Pathogen Panel Testing, effective Nov. 7, 2025
- CPCPLAB046 Biomarkers for Myocardial Infarction and Chronic Heart Failure, effective Nov. 7, 2025
- CPCPLAB047 Pancreatic Enzyme Testing for Acute Pancreatitis, effective Nov. 7, 2025
- CPCPLAB048 Folate Testing, effective Nov. 7, 2025
- CPCPLAB049 General Inflammation Testing, effective Nov. 7, 2025
- CPCPLAB057 Coronavirus Testing in the Outpatient Setting, effective Nov. 7, 2025
- CPCPLAB063 Identification of Microorganisms Using Nucleic Acid Probes, effective Nov. 7, 2025
- CPCP017 Wasted/Discarded Drugs and Biologicals Policy, effective Nov. 25, 2025
- CPCP012 Hernia Repair, effective Nov. 25, 2025
View the policies.
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Clinical payment and coding policies are based on health care professionals’ and industry standard guidelines. The clinical payment and coding guidelines are not intended to provide billing or coding advice but to serve as a reference for facilities and providers.