CPT 36591 is referenced in 5 tracked payer policy changes from Anthem BCBS, Independence Blue Cross, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 36591 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Effective January 1, 2027, HealthKeepers, Inc. (Anthem HealthKeepers Plus Medicaid in Virginia) will discontinue reimbursement for 44 specific procedure codes to align with the Virginia Department of Medical Assistance Services (DMAS) fee schedule. The practice must stop billing these codes for dates of service on or after that date, as claims for discontinued codes will be denied or subject to adjustment and recovery.
Independence Blue Cross has updated policy 00.01.52ad to clarify that venipuncture (CPT codes 36400, 36405, 36406, 36410, 36415, 36416, 36591, 36592) is not eligible for separate reimbursement to outpatient facilities when performed incidental to laboratory services. These codes are now added to Attachment D, meaning they cannot be billed separately when reported with other services on the same date by the same provider.
Capital Blue Cross issued a multi-topic administrative bulletin with four key changes: (1) new Availity electronic appeals training available, (2) new venipuncture reimbursement policy effective October 1, 2026 requiring separate lab facility billing, (3) retirement of global obstetrical policy with transition to visit-based billing September 1–December 31, 2026, and (4) updates to preauthorization requirements for specific chemotherapy and durable medical equipment codes across multiple plan types.
Already effective August 24, 2026, AHCCCS prepayment reviews claims for H2038 (skills training and development, per diem) billed without a group modifier, and supporting medical documentation must be submitted with the initial claim and every replacement claim. Already effective September 4, 2026, the Alivia analytics tool reviews NEMT trip tickets and a set of claim edits, and claims containing the listed errors will be denied. Already effective September 1, 2026, claims submitted by fee-for-service providers that include a referring, ordering, attending or prescribing provider who is not registered with AHCCCS will be denied.
Independence Blue Cross updated policy 00.01.52ad effective 11/02/2026 to clarify that venipuncture (CPT codes 36400, 36405, 36406, 36410, 36415, 36416, 36591, 36592) is not eligible for separate reimbursement when performed incidental to laboratory services at outpatient facilities. The billing team must stop billing these codes separately when submitted with lab work on the same date and ensure claims are submitted correctly to avoid denial.
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