CPT 90882 is referenced in 5 tracked payer policy changes from Sentara Health Plans, Harvard Pilgrim Health Care, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 90882 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Starting January 1, 2027, Sentara Health Plans will require prior authorization for a long list of codes on Virginia commercial plans, including self-funded (ASO) plans, and for code 88380 on commercial, Medicaid and Medicare products, plus code 22860 on Medicare products. Sentara will also stop covering a separate list of codes on Virginia commercial and self-funded plans.
Effective September 1, 2025, MassHealth is implementing a bundled encounter rate for Behavioral Health Urgent Care (BHUC) centers. BHUCs must now bill using HCPCS code H2013 with modifiers HB (adult) or HA (child/adolescent), accompanied by zero-pay service codes indicating the type of mental health service provided. The GJ modifier for enhanced urgent care rates is being discontinued for BHUCs and non-BHUC mental health centers.
Effective September 1, 2025, managed care entities must pay behavioral health urgent care providers (BHUCs) one encounter bundle per patient per day instead of each individual service, billed as H2013 with modifier HB for adults or HA for children and adolescents, at no less than the MassHealth fee-for-service minimum rate for the bundle code. The services listed in Table 2 are included in the bundle and must be reported on the claim with a zero charge. The GJ modifier for urgent services is not allowed beginning September 1, 2025.
Aetna has updated its EMDR therapy policy (CPB 0583) to cover EMDR ONLY for post-traumatic stress disorder (PTSD) treatment. All other uses—including anxiety disorders, chronic pain, depression, autism, substance abuse, and 40+ other conditions—are now classified as experimental/investigational and NOT covered. Billing teams must immediately deny or reject claims for EMDR when diagnoses fall outside the narrow PTSD coverage scope.
Wellcare's Diamond Designation Program rates specialist groups for Program Year 2025 on quality and efficiency, based largely on health plan claims from January 2021 through December 2023. The program covers 14 specialty types, including cardiology, orthopedic surgery, podiatry, psychiatry and pulmonology, and quality is emphasized over efficiency. Ratings are made available to primary care practitioners who refer members to specialty care, and the program is not used to determine payment under Wellcare pay-for-performance programs.
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