CPT 99355 is referenced in 3 tracked payer policy changes from Blue Cross of Idaho and Oregon Health Plan. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 99355 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Blue Cross of Idaho added a new Part 2 Substance Use Disorder (SUD) section to policy PAP229 effective October 2025. Providers treating or referring SUD patients must obtain documented patient consent before submitting claims containing Part 2 Records to the insurer, and must include specific notice that records are subject to the Part 2 Rule (42 C.F.R. Part 2). Claims submitted without proper consent will be denied.
Blue Cross of Idaho updated PAP229 to add Part 2 Substance Use Disorder (SUD) record handling requirements and clarified that medical records must be submitted with claims for specific prolonged service codes (99417, 99418, 99354-99357, 99358-99359, 99415-99416), modifier 22/63 claims, and observation stays exceeding 48 hours. Providers must now obtain and certify patient consent before submitting any SUD-related claims to Blue Cross.
Oregon Health Authority is increasing Medicaid fee-for-service primary care rates by 2%, raising the conversion factor from $27.82 to $28.50. This affects evaluation and management codes, immunization administration codes, and health/behavior assessment codes.
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