September 3, 2026
The following policies received their annual review with no changes:
Medically Unlikely Edits (MUEs)/Maximum Units of Service
The following policies received their annual review with the changes noted below:
Emergency Department Evaluation and Management Level of Service
- Removed Alaska lines of business and products from the exceptions section for dates of service on or after December 4, 2026.
Group Visits
- Changed the name from “Group Psychotherapy Services (90853)” to “Group Visits.”
- Within the policy section, added details for group preventive counseling, group education, and shared (group) medical appointments.
- Clarified details under group psychotherapy in the policy section.
- Added Current Procedural Terminology® (CPT) codes with descriptors under the codes/coding guidelines section.
- Added group psychotherapy and shared medical appointments to the definitions section.
Physical Medicine and Rehabilitation Services
- In the related claims section, added outpatient claims.
- In the policy section, added “always therapy multiple procedure reduction” information:
- Effective for dates of service on or after December 4, 2026, always therapy services are subject to a multiple therapy reduction of the practice expense component (the overhead and non-physician administrative costs required to run a medical or professional practice). Always therapy services are identified by the Multiple Procedure flag of 5 on the current Centers for Medicare & Medicaid Services (CMS) National Physician Fee Schedule (NPFS) Relative Value Guide.
- When 2 or more therapy procedures, subject to the multiple therapy reduction concept, are performed on the same patient by the same physician or other qualified healthcare professional at the same session.
Preadmission Services
- Added a description of hospital system.
- Added, “within the same hospital or effective with claim dates of service on or after December 4, 2026, the same hospital system,” to the paragraph for unplanned inpatient admissions via emergency room within the policy section.