Payment Policy Updates from September 2025

October 2, 2025

The following policies received their annual review with no changes:

• Inpatient Acute Transfers from DRG Hospitals
• Modifier SL – State Supplied Vaccine
• Multiple Diagnostic Cardiovascular Services Reductions
• Multiple Diagnostic Imaging Reductions
• Screening Services with Evaluation and Management (E&M) Services
• Serious Adverse Events – Inpatient Facility Services
• Urine Drug Testing and Drug Assay Services

The following policies received their annual review with the changes noted below:

Blood Draw/Venipuncture – 36415

• This policy is archived effective October 2, 2025. Please refer to the Medically Unlikely Edits (MUEs)/Maximum Units of Service policy.

Facility Fees: Clinic Services, Professional Fees and Specialty Services – Treatment Room

• From exceptions section, removed Alaska lines of business and COVID statement from 2023.

Global Surgery

• From the policy section, removed maternity global chart and added reference to the maternity services policy.
• Added Maternity Services policy to cross reference section.

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