All Insurance Policy Changes (Page 1367)

Continuing from page 1366. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Low impact
2026 LTCR Provider Webinar Training Opportunities
Texas Medicaid·Identified Jan 12, 2026
Texas Long-Term Care Regulation is offering multiple webinar training opportunities throughout January 2026 for various provider types including nursing facilities, assisted living facilities, and home health agencies. These are educational webinars covering topics like dementia care, infection control, and regulatory compliance.
Low impact
Long-Term Care Educational Opportunities Now Available
Texas Medicaid·Identified Jan 12, 2026
The Texas Health and Human Services Commission and UT Austin School of Nursing have launched free web-based educational modules for long-term care providers, covering topics like infection control, geriatric care, and mental health. These modules offer continuing education credits for nurses, CNAs, and administrators but do not affect billing procedures or codes.
Medium impact
EVV System Interruptions Update – Resolved as of Jan. 3
Texas Medicaid·Effective Jan 3, 2025
EVV (Electronic Visit Verification) system issues that were causing rejections of long-term care Medicaid visits have been resolved as of January 3rd. Providers who received visit rejections in error should resubmit them, and missing authorization data should be entered manually using information from MESAV in LTC TexMedConnect.
Low impact
Updated EVV Portal Reports and Training Materials Now Available
Texas Medicaid·Effective Oct 30, 2025
Texas Medicaid updated the EVV Portal reports on October 30, 2025, adding new fields to track alternative device usage for visit verification. Updated training materials were released on December 19, 2025, to help users understand the new reporting features.
Low impact
Members Sought for the Medicaid Advisory Committee
Texas Medicaid·Identified Jan 12, 2026
Texas Health and Human Services Commission is seeking applications for the Medicaid Advisory Committee (formerly Medical Care Advisory Committee) with appointments through December 31, 2031. Applications are due by January 27, 2026, with quarterly meetings in Austin.
High impact
2025-11-14 - Medicare Participation Announcement for CY 2026: Decide by December 31
Medicare/CMS·Effective Jan 1, 2026
Medicare providers must decide their participation status for 2026 by December 31, 2025. Participating providers receive 5% higher payments than non-participating providers and get paid directly by Medicare.
High impact
2025-11-20 - 2026 Medicare Parts A & B Premiums and Deductibles
Medicare/CMS·Effective Jan 1, 2026
Medicare Part A and B deductibles, coinsurance amounts, and premiums are increasing for 2026. Part A hospital deductible increases to $1,736 (+$60), Part B annual deductible increases to $283 (+$26), and various daily coinsurance rates for hospital stays and skilled nursing facilities are also rising.
High impact
2025-11-21 - Update on Processing of Medicare Claims Impacted During the Government Shutdown
Medicare/CMS·Effective Oct 1, 2025
Congressional action retroactively restored Medicare telehealth payment provisions effective October 1, 2025 through January 30, 2026. Previously returned telehealth claims can now be resubmitted, and the requirement to use GY modifiers on certain telehealth claims has been rescinded.
High impact
2025-11-24 - CMS Empowers Patients and Boosts Transparency by Modernizing Hospital Payments
Medicare/CMS·Effective Jan 1, 2026
CMS has released the CY 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System final rule, which modernizes hospital payments and enhances price transparency for Medicare beneficiaries. This rule introduces patient-focused reforms affecting hospital outpatient and ASC billing starting in 2026.
Medium impact
2025-11-26 - Medicare Participating Physician or Supplier Agreement Form Expires on November 30
Medicare/CMS·Effective Jan 1, 2026
The Medicare Participating Physician or Supplier Agreement Form CMS-460 expires on November 30, 2025, but Medicare Administrative Contractors will continue accepting the current version while it undergoes OMB review. Additionally, new telehealth services codes G0660-G0668 will be available starting January 1, 2026 for qualifying episodes under the Transforming Episode Accountability Model.
Medium impact
2025-12-03 - 2026 Medicare Participation Announcement
Medicare/CMS·Effective Jan 1, 2026
CMS announced the 2026 Medicare Participation updates with key focus on reducing administrative burden and improving program integrity. Home Health agencies will see an aggregate 1.3% decrease ($220 million) in Medicare payments for 2026 due to various adjustment factors despite a 2.4% base rate increase.
High impact
2025-12-04 - Outpatient Prospective Payment System Drug Acquisition Cost Survey Starts January 1: Get Key Dates & Details
Medicare/CMS·Effective Jan 1, 2026
CMS is launching a mandatory OPPS Drug Acquisition Cost Survey from January 1 - March 31, 2026, requiring hospitals that received OPPS payments for outpatient drugs from July 1, 2024 - June 30, 2025 to report drug acquisition costs. The survey aims to inform CY 2027 payment policy changes for hospital outpatient departments.
Medium impact
2025-12-11 - CMS Finalizes New DMEPOS Accreditation Provisions to Enhance Program Integrity
Medicare/CMS·Effective Jan 1, 2026
CMS has finalized new DMEPOS accreditation provisions to enhance program integrity, with multiple payment rate updates and billing changes effective January 1, 2026. Key changes include new institutional provider enrollment fees of $750, updated payment rates for various services, and new billing requirements for critical access hospitals.
Medium impact
2025-12-18 - MAHA ELEVATE Brings Lifestyle Medicine to Original Medicare
Medicare/CMS·Effective Sep 1, 2026
CMS announced the MAHA ELEVATE Model, a voluntary program funding up to 30 chronic disease prevention and lifestyle medicine programs starting September 2026. This newsletter also includes multiple other Medicare updates including drug survey requirements, billing code changes, and compliance tips.
Medium impact
2026-01-08 - CMS Announces $50 Billion in Awards to Strengthen Rural Health in All 50 States
Medicare/CMS·Identified Jan 12, 2026
CMS announces $50 billion Rural Health Transformation Program providing awards to all 50 states, establishes new Office of Rural Health Transformation, and introduces new ACO models (LEAD, GLOBE, GUARD, BALANCE) targeting rural providers and prescription drug costs. Multiple new models launching between 2026-2027 with applications opening in Spring 2026.
Medium impact
CPCP041 Sepsis Policy Updated Effective 04/01/2025
BCBS Texas·Effective Apr 1, 2025
Blue Cross and Blue Shield of Texas has revised the Clinical Payment and Coding Policy CPCP041 for Sepsis effective April 1, 2025. This is a fresh policy update that requires billing teams to review the updated sepsis-related billing and coding guidelines.
Medium impact
Annual Review: CPCP030 Point-of-Care Ultrasound (POCUS) Examination Policy Updated
BCBS Texas·Effective Jan 7, 2025
Blue Cross Blue Shield of Texas has updated the CPCP030 Point-of-Care Ultrasound (POCUS) Examination Policy, which contains new clinical payment and coding guidelines for ultrasound procedures performed at the point of care. The revised policy becomes effective January 7, 2025.
High impact
Prior Authorization Code Changes for Commercial Members Effective April 1, 2025
BCBS Texas·Effective Apr 1, 2025
Blue Cross Blue Shield of Texas is updating prior authorization requirements for commercial members effective April 1, 2025. Multiple specialty areas will have codes added or removed from prior authorization lists, including cardiology, genetic testing, musculoskeletal, medical oncology, and specialty pharmacy codes.
Medium impact
Annual Review: CPCP025 Corrected Claim Submission Updated Effective 01/08/2025
BCBS Texas·Effective Jan 8, 2025
Blue Cross Blue Shield of Texas has updated their Clinical Payment and Coding Policy CPCP025 for Corrected Claim Submission, effective January 8, 2025. The billing team needs to review the updated policy to understand any changes to procedures for submitting corrected claims.
Medium impact
Update: Routine Services and Supplies
BCBS Texas·Effective Jan 28, 2025
Blue Cross Blue Shield Texas updated their guidance on routine services and supplies, clarifying that providers should typically bundle these items into charges for other procedures rather than billing them separately. This references existing unbundling policies for both facility and professional providers.
High impact
Contracted Providers Must File Claims
BCBS Texas·Effective Jan 8, 2025
Blue Cross Blue Shield of Texas now requires contracted providers to file claims for all covered services rendered to BCBSTX enrollees. Providers cannot offer cash discounts in lieu of filing claims, as this violates their provider contract, though HIPAA patient self-pay directives must still be honored.
Medium impact
Policy Revised on Revenue Codes Requiring Supporting Codes for Outpatient Facility Claims, Effective April 14, 2025
BCBS Texas·Effective Apr 14, 2025
Blue Cross Blue Shield of Texas is revising Clinical Payment and Coding Policy CPCP018, which governs which revenue codes require supporting CPT, HCPCS, and/or NDC codes for outpatient facility claims. The revision includes updates to bill types, affecting how outpatient facilities must submit claims with proper supporting codes.
Medium impact
Avoid the Inappropriate Use of Antipsychotic Medication in Anxiety Disorders
BCBS Texas·Effective Jan 15, 2025
BCBS Texas issued guidance discouraging the inappropriate use of antipsychotic medications for treating anxiety disorders, as most are not FDA-approved for these conditions. The policy emphasizes careful risk-benefit assessment and provides clinical practice guidelines for anxiety disorder treatment.
Medium impact
Prior Authorization Code Updates for Medicare Advantage Members Effective April 1, 2025
BCBS Texas·Effective Apr 1, 2025
Blue Cross Blue Shield of Texas is updating prior authorization requirements for Medicare Advantage members effective April 1, 2025. Changes include adding new specialty drug codes and lab management codes that will require eviCore review, while removing some previously required lab management codes.
Medium impact
Pharmacy Program Quarterly Update Changes Effective Jan. 1, 2025 – Part 2
BCBS Texas·Effective Jan 1, 2025
Blue Cross and Blue Shield of Texas is adding 40+ new medications to multiple pharmacy formularies effective January 1, 2025, including biosimilars (adalimumab, infliximab, tocilizumab variants), specialty drugs (FABHALTA for paroxysmal nocturnal hemoglobinuria, LITFULO for alopecia areata), and new formulations (ATORVALIQ, EZALLOR SPRINKLE). This is Part 2 of the quarterly update and does not require member notification. The billing team must verify these drugs are now covered and update any prior authorization rules that may apply.

Browse by payer Browse by state Browse by specialty Browse by billing code Browse & filter all changes

Get alerts for changes like this

Save a search and receive a daily digest whenever a new policy change matches your filters.

Create a free alert

Archive by year

2023 2024 2025 2026

2026 LTCR Provider Webinar Training Opportunities

Long-Term Care Educational Opportunities Now Available

EVV System Interruptions Update – Resolved as of Jan. 3

Updated EVV Portal Reports and Training Materials Now Available

Members Sought for the Medicaid Advisory Committee

2025-11-14 - Medicare Participation Announcement for CY 2026: Decide by December 31

2025-11-20 - 2026 Medicare Parts A & B Premiums and Deductibles

2025-11-21 - Update on Processing of Medicare Claims Impacted During the Government Shutdown

2025-11-24 - CMS Empowers Patients and Boosts Transparency by Modernizing Hospital Payments

2025-11-26 - Medicare Participating Physician or Supplier Agreement Form Expires on November 30

2025-12-03 - 2026 Medicare Participation Announcement

2025-12-04 - Outpatient Prospective Payment System Drug Acquisition Cost Survey Starts January 1: Get Key Dates & Details

2025-12-11 - CMS Finalizes New DMEPOS Accreditation Provisions to Enhance Program Integrity

2025-12-18 - MAHA ELEVATE Brings Lifestyle Medicine to Original Medicare

2026-01-08 - CMS Announces $50 Billion in Awards to Strengthen Rural Health in All 50 States

CPCP041 Sepsis Policy Updated Effective 04/01/2025

Annual Review: CPCP030 Point-of-Care Ultrasound (POCUS) Examination Policy Updated

Prior Authorization Code Changes for Commercial Members Effective April 1, 2025

Annual Review: CPCP025 Corrected Claim Submission Updated Effective 01/08/2025

Update: Routine Services and Supplies

Contracted Providers Must File Claims

Policy Revised on Revenue Codes Requiring Supporting Codes for Outpatient Facility Claims, Effective April 14, 2025

Avoid the Inappropriate Use of Antipsychotic Medication in Anxiety Disorders

Prior Authorization Code Updates for Medicare Advantage Members Effective April 1, 2025

Pharmacy Program Quarterly Update Changes Effective Jan. 1, 2025 – Part 2