High impact
HealthPro News – October 2026
HMSA·Effective Jan 1, 2027
HMSA is eliminating coverage for Transitional Care Management (TCM) codes 99495 and 99496 for commercial and QUEST members effective January 1, 2027, while maintaining coverage for Medicare members. Billing teams must transition to standard evaluation and management codes for post-discharge services on commercial and QUEST plans. Additionally, ASAM 3.5 residential treatment authorizations for QUEST members will change to initial 15-day authorizations with continued-stay reviews starting January 1, 2027.