Clinical Payment and Coding Policy Updates

March 27, 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 code list was updated:  

  • CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) policy code list, effective June 15, 2025

The following policies were updated:

  • CPCP005 Home Health Care Policy, effective March 21, 2025
  • CPCP006 Preventive Services Policy, effective April 1, 2025
  • CPCP033 Telemedicine and Telehealth/Virtual Health Care Services, effective Jan. 1, 2025

The following policy is new:

  • CPCP043 Lactation Support Services, effective June 26, 2025

CPT copyright 2024 American Medical Association All rights reserved. CPT is a registered trademark of the AMA.

Clinical payment and coding policies are based on health care professional 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.

The information provided does not constitute coding or legal advice. Physicians and other health care providers should use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment, and to submit claims using the most appropriate code(s) based upon the medical record documentation, coding guidelines and reference materials.