Question 1

What insurance policy changes affect CPT 99235?

Accepted Answer

There are 2 tracked policy changes affecting CPT 99235, including updates from Maryland Medicaid, Oregon Health Plan. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Question 2

Which payers have updated policy for CPT 99235?

Accepted Answer

Payers that have issued tracked updates for CPT 99235 include: Maryland Medicaid, Oregon Health Plan.

Question 3

How do I get notified when CPT 99235 policy changes?

Accepted Answer

Create a free account at PolicyChanges.app and save a search filtered to CPT 99235. You will receive a daily digest email whenever a new policy change references this code.

Question 4

Why do payers change policies for CPT 99235?

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.

99235 Insurance Policy Changes

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

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