Question 1

What insurance policy changes affect CPT 99231?

Accepted Answer

There are 6 tracked policy changes affecting CPT 99231, including updates from Nevada Medicaid, Maryland Medicaid, New Jersey Medicaid. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Question 2

Which payers have updated policy for CPT 99231?

Accepted Answer

Payers that have issued tracked updates for CPT 99231 include: Nevada Medicaid, Maryland Medicaid, New Jersey Medicaid, Connecticut Medicaid (HUSKY Health), BCBS Texas, Oregon Health Plan.

Question 3

How do I get notified when CPT 99231 policy changes?

Accepted Answer

Create a free account at PolicyChanges.app and save a search filtered to CPT 99231. You will receive a daily digest email whenever a new policy change references this code.

Question 4

Why do payers change policies for CPT 99231?

Accepted Answer

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.

99231 Insurance Policy Changes

Attention Provider Type 20 (Physician, M.D., Osteopath, D.O.): Billing Instructions for Inpatient Hospital Care Including Critical Care

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

Newsletter Vol. 35, No.08

2025.87 - January 2026 Updates to the CMAP Telehealth Table - Subsequent Hospital Care & Nursing Facility Care

Consider Behavioral Health Evaluations During Hospital Stays

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