What insurance policy changes affect CPT 99211?

There are 46 tracked policy changes affecting CPT 99211, including updates from NC Medicaid - NCDHHS, CareSource, Healthfirst. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 99211?

Payers that have issued tracked updates for CPT 99211 include: NC Medicaid - NCDHHS, CareSource, Healthfirst, MassHealth, Blue Cross Blue Shield of North Dakota, Blue Cross Blue Shield of Rhode Island, Blue Cross of Idaho, Ambetter, Health Net, Anthem BCBS, Maryland Medicaid, Harvard Pilgrim Health Care, CareFirst BlueCross BlueShield, New Jersey Medicaid, Medical Mutual of Ohio, Blue Cross Blue Shield of Wyoming, Aetna, Connecticut Medicaid (HUSKY Health), Kansas Medicaid (KanCare), Alaska Medicaid, Oregon Health Plan, Indiana Medicaid (IHCP), BCBS Michigan.

How do I get notified when CPT 99211 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 99211. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 99211?

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.

99211 — A nurse or other healthcare provider handles your visit without the doctor present, for a simple follow-up concern.: Insurance Policy Changes

99211 Insurance Policy Changes

CPT 99211, in plain terms, covers A nurse or other healthcare provider handles your visit without the doctor present, for a simple follow-up concern. CPT 99211 is referenced in 46 tracked payer policy changes from NC Medicaid - NCDHHS, CareSource, and 21 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 99211 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Medium impact

Tourette's Syndrome (CPB 0480, reviewed 2026-07-24)

Aetna·Effective Jul 24, 2026

Aetna updated its Tourette's Syndrome clinical policy (CPB 0480) establishing medical necessity criteria and clearly delineating covered versus experimental/investigational treatments. Covered services include behavioral intervention (CBIT), specific pharmacotherapies, psychotherapy, and limited assessment tools (EEG/neuro consult only with focal signs). Most advanced interventions including deep brain stimulation, transcranial stimulation, neuroimaging, and biomarker testing are classified as experimental and not covered. Billing teams must immediately align claims submission and prior authorization processes to this framework.

Transition to American Medical Association Maternity Current Procedural Terminology 2027 Code Changes Effective Jan. 1, 2027

[Ohio] OAC Rule 5160-1-17.9 Ordering, Referring and Prescribing Providers

Provider Updates for September 2026

All Provider Bulletin 419: Transition to Separate Reporting of Maternity Care Services

Use of Modifier AF - Medicaid Expansion Only

Tips and documentation standards for interactive complexity and psychotherapy with E/M services

PAP311 - Add-on Code G2211 - Provider policy consolidation project. Merged MAPAP258 into this policy.

Healthfirst’s Obstetric Billing Guidelines Reimbursement Policy

Ambetter Health Billing Code Update for HCPC Codes G2211 & G2212

Ambetter Health Billing Code Update for HCPC Codes G2211 & G2212: Effective 04/01/2026

Ambetter Health Billing Code Update for HCPC Codes G2211 & G2212: Effective 04/01/2026

26-085 Important Update to Medicare Add-On Codes G2211 and G2212

[Ohio] Reimbursement policy update: Modifiers 25 and 57: Evaluation and Management with Global Procedures

[Virginia] Reimbursement policy update: Modifiers 25 and 57: Evaluation and Management with Global Procedures

PT 66-26: Federally Qualified Health Center and Rural Health Center Coding Guidelines

All Provider Bulletin 408: Annual Behavioral Health Wellness Examinations

Billing updates for mental health centers

Managed Care Entity Bulletin 135: Mental Health Center Policy Updates

Maryland Medicaid enhanced reimbursement rates for eligible primary care providers, effective August 1, 2025

PT 88-25: Primary Care Investment: E&M Increases

Newsletter Vol. 35, No.08

20-611 Clarify the Use of Modifier 25 and CPT Code 99211

20-612 Clarify the Use of Modifier 25 and CPT Code 99211

Mutual News Q1 2020 Newsletter

COVID-19 Billing Guidance – UPDATE!

Tourette's Syndrome (CPB 0480, reviewed 2026-07-24)

Clarification on Updates to Fee Schedules and Rate Increases for Select Behavioral Health Services

[California] Reimbursement policy update: Modifiers 25 and 57: Evaluation and Management with Global Procedures

[New York] Reimbursement policy update: Modifiers 25 and 57: Evaluation and Management with Global Procedures

[Georgia] Reimbursement policy update: Modifiers 25 and 57: Evaluation and Management with Global Procedures

PT 49-26: GE Modifier Clarification

KMAP BULLETIN: Diagnosis Requirements for Evaluation and Management Services – Certified Community Behavioral Health Clinics

KMAP BULLETIN: Pediatrician Rate Increase for Office Visit Codes

Newsletter Vol. 35, No.07

KMAP BULLETIN: Billing Guidelines and Required Documentation for Visit Complexity Add-on Code G2211

Vision Exam Limit Clarification

Proposed Amendments to COMAR 10.09.02 Physicians'' Services

General Provider Transmittal

Notice of intent – OHA will amend the Medicaid State Plan to increase fee-for-service primary care rates.

20-297 Complete the IHA within 120 Days to Help Manage Your Patient’s Health Care Needs

20-298 Complete the IHA within 120 Days to Help Manage Your Patient’s Health Care Needs

Guidelines for Coding a Wellness Visit and Sick Visit Occurring on the Same Day

Best Practices and Coding to Accurately Capture Follow-Up Visits for TRC and FMC HEDIS Measures

PAP304 - Prenatal and Postpartum Care Coding for HEDIS Quality - New

BT202146: Notification of Pregnancy code and modifier (99354 TH) denying for NCCI MUE

Do you have time for a Quality Minute about annual wellness visits?