December 4, 2025
The following policies received their annual review with no changes:
The following policies received their annual review with changes noted below:
Medicare Status B/P/T
- Removed cross reference to personal protective equipment (PPE) policy archived October 7, 2025.
- In the policy section, removed the effective date for Status P codes.
- In the coding section, removed the effective date for code G2211.
- In the coding section, removed the Status Indicator B effective date for current procedural terminology (CPT) 99072.
Physical Therapy (PT)- Occupational Therapy (OT)- Speech Therapy (ST) Therapy Services
Update on Payment Policy for Physical Medicine and Rehabilitation Services
We want to clear up any confusion about our payment policy:
- Premera has not changed how we pay for Physical Medicine and Rehabilitation Services.
- We still use AMA timing rules, just like we always have.
- The recent update was only meant to help explain billing—not to change payments.
- Because the update caused confusion, we’re removing that clarification.
- Bottom line: Nothing has changed. We continue to pay the same way we always have.
If you have questions, please reach out. We’re here to help and want to make sure you have the facts.
Anesthesia Guidelines
- Added a reimbursement statement for modifier QZ within the policy section:
- “Effective dates of service on and after March 6, 2026, reimbursement will change from 100% to 85% of the provider’s applicable fee schedule allowed amount.”