June 24, 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. This information is a resource for our payment policies. It’s not intended to address all 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 was updated posted June 13, 2025
The following policies were updated:
- CPCP016 Chiropractic Services, effective June 20, 2025
- CPCP038 Outpatient Services Prior to IP Readmission, effective June 20, 2025
- CPCP039 OP Facility Services Overlapping During IP Stay effective, June 20, 2025
- CPCP040 Physical Medicine effective, Sept. 22, 2025
- CPCP006 Preventive Services Policy, effective July 1, 2025
CPT copyright 2024 American Medical Association. All rights reserved. CPT is a registered trademark of the AMA.
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.