June 4, 2026
The following policies received their annual review with no changes:
The following policies received their annual review with the changes noted below:
Global Surgery
- In the policy section under XXX global codes:
- A subset of XXX codes represents procedures that include pre-, intra-, and post-procedural work.
- Because this work is already part of the procedure, the Evaluation and Management visits (E&M) should not be billed separately.
- If documentation supports a separate and significant E&M service on the same day as the XXX procedure that goes beyond the routine work of the procedure, the E&M service may be billed with modifier 25
- See the below section "Significant, Separately Identifiable E&M Service on the Same Day of a Procedure or Other Service: Modifier 25"
- See the cross-reference policy: Modifier 25 – Significant, Separately Identifiable Evaluation and Management (E&M) Service on the Same Day of a Procedure or Other Service
- See the National Correct Coding Initiative (NCCI) manual
- Effective for dates of service September 4, 2026 and after, Evaluation and Management visits (E&M) billed on the same date as XXX procedures may be denied as inclusive to the XXX procedure.
- XXX codes have no preoperative and no postoperative period
- In the Modifier 25 section: Added “XXX” to the list of procedures where an E&M with modifier 25 is not appropriate when the visit is solely for the performance of the procedure.
Modifier 25
- Added “XXX” procedures to the list in the policy section where modifier 25 is not appropriate solely for the performance of the procedure.
Modifier 26/TC
- Clarified the description of the NPFS indicator details for modifier 26 and TC details in the 1st, 2nd, and 3rd paragraph of the policy section.
Modifier 33-Preventive Services
Updated Preventive Service recommendation organizations to mirror AMA guidelines and Preventive benefit guideline medical policy references:
- United States Preventive Services Task Force (USPSTF) grade A or B recommendations
- Advisory Committee on Immunization Practices (ACIP) recommendations adopted by the Director of the Center for Disease Control and Prevention (CDC)
- Health Resources and Services Administration (HRSA) supported comprehensive guidelines which are published by any of the following sources:
- The Bright Futures Recommendations for Pediatric Preventive Health Care schedule of services
- Uniform Panel of the Secretary’s Advisory Committee on Heritable Disorders in Newborns and Children
- Specific women’s health care services and guidelines adopted by HRSA
Multiple Modifiers
- To Policy section added reimbursement modifiers: CO, CQ, QZ.
Multiple Endoscopic procedure reductions
- Correction to statement regarding procedures billed on the same claim in policy section: removed “All diagnostic imaging procedures” and added “All endoscopic procedures rendered to a member by the same provider on the same date of service should
be billed on a single claim.”