Reimbursement Policy Updates

Aug. 25, 2026

Reimbursement policies, formerly known as clinical payment and coding policies, describe payment rules and methodologies for Current Procedural Terminology (CPT^®) codes, Healthcare Common Procedure Coding System and ICD-10 coding for claims submitted as covered services. These policies are not intended to address all coding or reimbursement related issues. We regularly add and modify reimbursement policy positions as part of our ongoing policy review process.  

The following policies were updated:

RP016 Chiropractic Care Services, effective July 24, 2026
RP043 Lactation Support Services, effective July 24, 2026
RP021 Laboratory Panel Billing, effective Aug. 21, 2026
RP031 Trauma Activation - Facility Services, effective Aug. 14, 2026
RP035 Unlisted/Not Otherwise Classified (NOC) Coding Policy, effective Aug. 14, 2026
RP052 Robotic Assisted Surgery, effective Nov. 16, 2026
RPLAB004 Diabetes Mellitus Testing, effective Dec. 4, 2026
RPLAB014 Prenatal Screening (Nongenetic), effective Dec. 4, 2026
RPLAB032 Oral Cancer Screening and Testing, effective Dec. 4, 2026
RPLAB045 Pathogen Panel Testing, effective Dec. 4, 2026
RPLAB046 Biomarkers for Myocardial Infarction and Chronic Heart Failure, effective Dec. 4, 2026
RPLAB049 General Inflammation Testing, effective Dec. 4, 2026
RPLAB050 Urine Culture Testing for Bacteria, effective Dec. 4, 2026
RPLAB056 Gamma-glutamyl Transferase Testing in Adults, effective Dec. 4, 2026
RPLAB057 Coronavirus Testing in the Outpatient Setting, effective Dec. 4, 2026
RPLAB061 Testing for Alpha-1 Antitrypsin Deficiency, effective Dec. 4, 2026
RPLAB063 Identification of Microorganisms Using Nucleic Acid Probes, effective Dec. 4, 2026
RPLAB071 Colorectal Cancer Screening, effective Dec. 4, 2026

Reimbursement policies are based on using healthcare professionals and industry standard guidelines. The coding guidelines are not intended to provide billing or coding advice but to serve as a reference for facilities and providers.