Feb. 25, 2025
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 clinical payment and coding policy positions as part of our ongoing policy review process.
The following policy was updated:
- CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services policy was updated Effective 5.15.25
The following lab management policies were updated:
- CPCPLAB003 Vitamin D, effective April 15, 2025
- CPCPLAB004 Diabetes Mellitus Testing, effective April 15, 2025
- CPCPLAB008 Diagnostic Testing of Iron, effective April 15, 2025
- CPCPLAB009 Testosterone Effective April 15, 2025
- CPCPLAB010 Vitamin B12 and Methylmalonic Acid Testing, effective April 15, 2025
- CPCPLAB020 Cardiovascular Disease Risk Assessment, effective April 15, 2025
- CPCPLAB023 Diagnosis of Idiopathic Environmental Intolerance, effective April 15, 2025
- CPCPLAB028 Immune Cell Function Assay, effective April 15, 2025
- CPCPLAB032 Oral Cancer Screening and Testing, effective April 15, 2025
- CPCPLAB038 Urinary Tumor Markers for Bladder Cancer, effective April 15, 2025
- CPCPLAB045 Pathogen Panel Testing, effective April 15, 2025
- CPCPLAB051 Diagnostic Testing of Common Sexually Transmitted Infections, effective April 15, 2025
- CPCPLAB057 Coronavirus Testing in the Outpatient Setting ,effective April 15, 2025
- CPCPLAB067 Testing of Homocysteine Metabolism-Related Conditions, effective April 15, 2025
- CPCPLAB069 Immunohistochemistry, effective April 15, 2025
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Clinical payment and coding policies are based on using healthcare professionals and industry standard guidelines. The clinical payment and coding guidelines are not intended to provide billing or coding advice but to serve as a reference for facilities and providers.