What insurance policy changes affect CPT 99305?

There are 8 tracked policy changes affecting CPT 99305, including updates from Maryland Medicaid, CareFirst BlueCross BlueShield, New Jersey Medicaid. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 99305?

Payers that have issued tracked updates for CPT 99305 include: Maryland Medicaid, CareFirst BlueCross BlueShield, New Jersey Medicaid, Connecticut Medicaid (HUSKY Health), Blue Cross of Idaho, Oregon Health Plan.

How do I get notified when CPT 99305 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 99305. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 99305?

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.

99305 — Your doctor's first visit to evaluate you in a nursing home with moderately complex medical decision-making.: Insurance Policy Changes

99305 Insurance Policy Changes

CPT 99305, in plain terms, covers Your doctor's first visit to evaluate you in a nursing home with moderately complex medical decision-making. CPT 99305 is referenced in 8 tracked payer policy changes from Maryland Medicaid, CareFirst BlueCross BlueShield, and 4 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 99305 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Medium impact

MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Updated language CCM, VCS, CoCM, and telehealth

Blue Cross of Idaho·Effective Aug 1, 2025

Blue Cross of Idaho updated FQHC billing requirements for Medicare Advantage patients, removing MMCP/IMP billing requirements and clarifying language for Chronic Care Management (CCM), Virtual Communication Services (VCS), Psychiatric Collaborative Care Model (CoCM), and telehealth services. FQHCs must continue using specific revenue codes and HCPCS codes for qualifying services under the CMS Prospective Payment System.

99305 Insurance Policy Changes

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

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

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

MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Updated language CCM, VCS, CoCM, and telehealth

MAPAP113 - Billing Requirements for Rural Health Centers (RHCs) - Revised exclusions added

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