What insurance policy changes affect CPT 98004?

There are 9 tracked policy changes affecting CPT 98004, including updates from Highmark, Florida Blue, CareSource. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 98004?

Payers that have issued tracked updates for CPT 98004 include: Highmark, Florida Blue, CareSource, Connecticut Medicaid (HUSKY Health), Indiana Medicaid (IHCP), Alaska Medicaid.

How do I get notified when CPT 98004 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 98004. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 98004?

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.

98004 — A synchronized audio-video consultation between a doctor and patient over video for an established patient visit.: Insurance Policy Changes

98004 Insurance Policy Changes

CPT 98004, in plain terms, covers A synchronized audio-video consultation between a doctor and patient over video for an established patient visit. CPT 98004 is referenced in 9 tracked payer policy changes from Highmark, Florida Blue, and 4 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 98004 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact

[Ohio] Telehealth: Updates to the OAC Rule Effective Date January 1, 2026

CareSource·Effective Jan 1, 2026

Ohio Medicaid updated telehealth eligibility rules effective January 1, 2026, expanding eligible providers (adding doulas and lactation consultants) and eligible services (adding doula services, nurse home visiting, PrEP counseling, and EAPG codes). Billing requirements now mandate rendering provider NPI submission for all telehealth claims, and new telemedicine codes 98000-98016 should use POS 02/10 without GT or U modifiers.

98004 Insurance Policy Changes

Highmark’s Telehealth Policy Will Be Updated on Sept. 1

Important Policy Update: Telemedicine Evaluation and Management Services

[Ohio] Telehealth: Updates to the OAC Rule Effective Date January 1, 2026

[Ohio] Telehealth: Updates to the OAC Rule

Hospital Monthly Important Message - 08.18.2025

BT202592: IHCP updates CCBHC encounter codes

BT202593: IHCP updates FQHC and RHC encounter codes

Hospital Monthly Important Message - 09.15.2025

February 2025 Town Hall FAQ