November 6, 2025
The following policies received their annual review with no changes:
The following policies are new and will be effective after the 90-day notification on February 6, 2026:
The following policies received their annual review with the changes noted below:
Anesthesia Guidelines
- Added modifier specific details from the archived anesthesia modifier policy.
- Removed archived anesthesia modifier policy from cross reference section.
Maternity Services
- Clarified the following details in the policy section:
- To the policy section, added clarifying details for postpartum care term from “up to six to eight weeks” to “45 days after vaginal delivery or 90 days after Cesarean delivery.”
- To the complication services section, added clarifying details of when modifier 22 could be applied to the delivery only code:
- Repair of third- or fourth-degree lacerations at the time of delivery
- Preterm labor with or without tocolytic
- Premature rupture of membranes occurring less than 37 weeks gestation
- Intrauterine growth retardation
- Oligohydramnios, polyhydramnios
- To the complication services section, added clarifying details: Repair of third- or fourth-degree lacerations at the time of delivery may be reported, by using a current procedural terminology (CPT) code from the integumentary section (e.g.,
12041-12047 or 13131-13133), when billing a global maternity code.
- To the complication services, section added clarifying details:
- For external cephalic version, use CPT 59412 in addition to the delivery code (or global maternity services code).
- Additional visits or procedures performed to support complex services should be billed separately from the global maternity codes and not indicated with modifier 22 on the global maternity code. An appropriate modifier should be used
when appropriate to indicate the separate services.
- Some examples of maternity complications where modifier 22 may be appended to the global maternity code or delivery only code, when supported by the documentation, include, but are not limited to, the following.
- High risk pregnancies (for example, cardiac conditions, insulin dependency, chronic hypertension, severe pulmonary conditions, conditions with platelet deficiency, thrombophlebitis, juvenile arthritis, any material disease or complications
requiring extensive testing and monitoring).
- Maternal severe hypertension/preeclampsia of pregnancy, including Hemolysis Elevated Liver Enzymes and Low Platelets (HELLP) syndrome.
- Cesarean delivery of multiples when substantial increased work is reflected within the documentation.
- To the policy section, added clarifying details for postpartum care term "up to six to eight weeks" to "45 days after vaginal delivery or 90 days after Cesarean delivery."
Modifier 52 – Reduced Services
- In the exceptions section, added “Effective with dates of service on and after February 6, 2026, reimbursement for procedures appended with modifier 52 will change from 75% to 50% of the Alaska provider’s applicable fee schedule allowed amount.”
Modifier 80, 81, 82 – Assistant Surgeons (Physician)
- Added to the exceptions section “Effective with dates of service on and after February 6, 2026, reimbursement will change from 20% to 16% of the Alaska provider’s applicable fee schedule allowed amount for the primary surgery.”
The following policies were archived:
Anesthesia Modifiers
- Added statement in policy section, “This policy is archived effective October 7, 2025. Please refer to the anesthesia guidelines policy.”
COVID-19 Testing: Diagnostic, Surveillance, and Over the Counter
- Added statement in policy section “This policy is archived effective February 6, 2026. Please see our related laboratory reimbursement policies which are a subsection of medical policies.”
Personal Protective Equipment (PPE)
- Added statement in policy section “This policy is archived effective October 7, 2025. Please refer to the Medicare Indicator Status B and Status T Services Reimbursement policy.”
Urine Drug Testing
- Added statement in policy section “This policy is archived effective February 6, 2026. Please see our related laboratory reimbursement policies which are a subsection of medical policies.”