Oct. 29, 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:
- CPCP003 Emergency Department Services Evaluation and Management – EM Coding – Facility Services, effective Oct. 6, 2025
- CPCP007 Implant, Device, and Tissue Policy, effective Jan. 19, 2026
- CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services Policy, effective Jan. 1, 2026
- CPCP028 Non-Reimbursable EIU Services Code List, effective Jan. 1, 2026
- CPCP031 Trauma Activation – Facility Services, effective Jan. 6, 2026
- CPCP034 Unbundling Policy – Professional Providers, effective Jan. 19, 2026
- CPCP035 Unlisted/Not Otherwise Classified Coding Policy, effective Oct. 17, 2025
- CPCPLAB002 Cervical Cancer Screening, effective Jan. 3, 2026
- CPCPLAB004 Diabetes Mellitus Testing, effective Jan. 3, 2026
- CPCPLAB005 Prostate Biopsy Specimen Analysis, effective Jan. 3, 2026
- CPCPLAB014 Prenatal Screening (Nongenetic), effective Jan. 3, 2026
- CPCPLAB017 Celiac Disease Testing, effective Jan. 3, 2026
- CPCPLAB024 Epithelial Cell Cytology in Breast Cancer Risk Assessment, effective Jan. 3, 2026
- CPCPLAB025 Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing, effective Jan. 3, 2026
- CPCPLAB026 Fecal Calprotectin Testing in Adults, effective Jan. 3, 2026
- CPCPLAB027 Testing for Diagnosis of Active or Latent Tuberculosis, effective Jan. 3, 2026
- CPCPLAB030 In Vitro Chemoresistance and Chemosensitivity Assays, effective Jan. 3, 2026
- CPCPLAB032 Oral Cancer Screening and Testing, effective Jan. 3, 2026
- CPCPLAB035 Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease, effective Jan. 3, 2026
- CPCPLAB036 Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases, effective Jan. 3, 2026
- CPCPLAB045 Pathogen Panel Testing, effective Jan. 3, 2026
- CPCPLAB050 Urine Culture Testing for Bacteria, effective Jan. 3, 2026
- CPCPLAB051 Diagnostic Testing of Common Sexually Transmitted Infections, effective Jan. 3, 2026
- CPCPLAB052 Testing for Vector-Borne Infections, effective Jan. 3, 2026
- CPCPLAB053 β - Hemolytic Streptococcus Testing, effective Jan. 3, 2026
- CPCPLAB056 Gamma-glutamyl Transferase Testing in Adults, effective Jan. 3, 2026
- CPCPLAB061 Testing for Alpha-1 Antitrypsin Deficiency, effective Jan. 3, 2026
- CPCPLAB065 Human Immunodeficiency Virus, effective Jan. 3, 2026
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Clinical payment and coding policies are based on using healthcare 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.