What insurance policy changes affect CPT 91318?

There are 6 tracked policy changes affecting CPT 91318, including updates from Indiana Medicaid (IHCP), CareSource, Aetna Better Health of Virginia. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 91318?

Payers that have issued tracked updates for CPT 91318 include: Indiana Medicaid (IHCP), CareSource, Aetna Better Health of Virginia, Medicare/CMS, Nevada Medicaid, Pennsylvania Medicaid (DHS).

How do I get notified when CPT 91318 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 91318. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for CPT 91318?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

PAYER POLICY CHANGES

91318 Insurance Policy Changes

CPT 91318 is referenced in 6 tracked payer policy changes from Indiana Medicaid (IHCP), CareSource, and 4 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 91318 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Indiana Medicaid (IHCP) · Effective Jan 1, 2027High impact
BT2026182: COVID-19 vaccine administration to no longer be carved out of managed care
Effective January 1, 2027, COVID-19 vaccine administration services transition from carved-out status to managed care for HIP, Hoosier Healthwise, Hoosier Care Connect, and Indiana PathWays members. Claims for COVID-19 vaccines and administration with service dates on or after 2027-01-01 must be submitted to the member's MCO instead of fee-for-service. FQHCs and RHCs remain carved out and continue submitting to FFS processors.
CareSource · Effective Jul 1, 2026High impact
[Ohio] Vaccine for Children Program Administration Billing Guidance
Effective July 1, 2026, CareSource will reject vaccine administration claims billed with CPT codes 90471 or 90472 for VFC-covered toxoids when the provider is part of the VFC program. VFC providers must use CPT code 90460 instead for vaccine administration of covered toxoids.
Aetna Better Health of Virginia · Effective Jan 1, 2026High impact
New Policy Updates - Clinical Payment Coding and Policy Changes effective January 1, 2026
Aetna Better Health of Virginia implemented six new clinical payment and coding policies effective January 1, 2026, establishing diagnosis requirements and billing restrictions for cerumen removal, outpatient consultations, coronary FFR testing, immunization administration, SDOH risk assessments, thyroid testing, and serum iron studies. Billing teams must implement claims edits to enforce these restrictions or face claim denials.
Medicare/CMS · Effective Jan 1, 2026Medium impact
2025-12-11 - CMS Finalizes New DMEPOS Accreditation Provisions to Enhance Program Integrity
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.
Nevada Medicaid · Identified Jun 21, 2026Medium impact
COVID-19 UNWIND: Claims for COVID-19 Administration and Vaccine Procedure Codes Reprocessed
Nevada Medicaid has reprocessed COVID-19 vaccine and administration claims that were incorrectly denied between September 11-November 18, 2023. Results appear on June 29, 2024 remittance advice, and providers can appeal any remaining denials.
Pennsylvania Medicaid (DHS) · Identified Jun 20, 2026Medium impact
MAB2024012401
The MA Program Vaccine Desk Reference lists the CPT codes and code descriptions on the MA Program Fee Schedule that are used for administering vaccines. It covers vaccines including respiratory syncytial virus, influenza, pneumococcal, hepatitis, meningococcal, zoster, rabies, and SARS-CoV-2 vaccines. The reference will be updated when new vaccine administration procedure codes are added to the fee schedule or when current procedure codes are updated.

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BT2026182: COVID-19 vaccine administration to no longer be carved out of managed care

[Ohio] Vaccine for Children Program Administration Billing Guidance

New Policy Updates - Clinical Payment Coding and Policy Changes effective January 1, 2026

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

COVID-19 UNWIND: Claims for COVID-19 Administration and Vaccine Procedure Codes Reprocessed

MAB2024012401

What insurance policy changes affect CPT 91318?

Which payers have updated policy for CPT 91318?

How do I get notified when CPT 91318 policy changes?

Why do payers change policies for CPT 91318?