What insurance policy changes affect CPT 99291?

There are 19 tracked policy changes affecting CPT 99291, including updates from Anthem BCBS, PacificSource Health Plans, Providence Health Plan. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 99291?

Payers that have issued tracked updates for CPT 99291 include: Anthem BCBS, PacificSource Health Plans, Providence Health Plan, Nevada Medicaid, BCBS Texas, CareFirst BlueCross BlueShield, Maryland Medicaid, New Jersey Medicaid, Blue Cross of Idaho, Oregon Health Plan.

How do I get notified when CPT 99291 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 99291. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 99291?

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.

99291 — A doctor's initial hour of intensive care for a critically ill or injured patient requiring constant monitoring and complex decision-making.: Insurance Policy Changes

99291 Insurance Policy Changes

CPT 99291, in plain terms, covers A doctor's initial hour of intensive care for a critically ill or injured patient requiring constant monitoring and complex decision-making. CPT 99291 is referenced in 19 tracked payer policy changes from Anthem BCBS, PacificSource Health Plans, and 8 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 99291 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact

Special Alert June 2026 - UPDATE Part 2 - Alert for 6.1 and 7.1 Coding and Reimbursement Policy Changes

Providence Health Plan·Effective Jun 1, 2026

Providence Health Plan implemented four coding and reimbursement policy changes effective June 1 and July 1, 2026: (1) rescinded the inpatient sepsis DRG length-of-stay edit; (2) will deny critical care services (99291/99292) billed in the ED when patients are discharged home; (3) will deny surgical procedures (CPT 10000-69999) missing required anatomical modifiers (RT, LT, E1-E4, etc.); and (4) will no longer reimburse additional units for anesthesia physical status modifiers P3, P4, P5 on commercial plans. These changes require immediate updates to billing logic, provider documentation requirements, and claim submission processes.

99291 Insurance Policy Changes

[California] Critical Care to Home: what care providers need to know

Hospital observation services: billing and reimbursement policy updates

Special Alert April 2026 - Alert for 6.1 Coding and Reimbursement Policy Changes

Special Alert May 2026 - UPDATE Alert for 6.1 and 7.1 Coding and Reimbursement Policy Changes

Special Alert June 2026 - UPDATE Part 2 - Alert for 6.1 and 7.1 Coding and Reimbursement Policy Changes

Special Alert May 2026 - UPDATE Alert for 6.1 and 7.1 Coding and Reimbursement Policy Changes

Special Alert April 2026 - Alert for 6.1 Coding and Reimbursement Policy Changes

[Georgia] New reimbursement policy: Critical Care to Home — Facility

[California] New reimbursement policy: Critical Care to Home — Facility

[New York] New reimbursement policy: Critical Care to Home — Facility

[Ohio] New reimbursement policy: Critical Care to Home — Facility

[Virginia] New reimbursement policy: Critical Care to Home — Facility

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

Five New Claims Editing Rules will be Implemented November 2025

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

PAP416 - Trauma Center Designation and Payment Policy - Included reference to Hospital contract for specially contracted terms

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