CPT 99360, in plain terms, covers A doctor waits nearby and stays available during a procedure in case they're needed to help. CPT 99360 is referenced in 3 tracked payer policy changes from Texas Medicaid and Oregon Health Plan. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 99360 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 99360 on AAPC
Effective June 15, 2026, CPT code 99360 will be removed from the CSHCN Services Program Provider Manual's Physician chapter as it is not a covered benefit. This affects critical care services and prolonged physician services sections in the manual.
Effective June 1, 2026, Texas Medicaid will remove CPT code 99360 from covered newborn services as it is not a reimbursable benefit. Providers must stop billing this code for Texas Medicaid patients to avoid claim denials.
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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