What insurance policy changes affect CPT 99394?

There are 29 tracked policy changes affecting CPT 99394, including updates from Harvard Pilgrim Health Care, New Mexico Medicaid, Health Net. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 99394?

Payers that have issued tracked updates for CPT 99394 include: Harvard Pilgrim Health Care, New Mexico Medicaid, Health Net, Anthem BCBS, Maryland Medicaid, Blue Cross of Idaho, MassHealth, CareSource, CareFirst BlueCross BlueShield, New Jersey Medicaid, Nevada Medicaid, Kansas Medicaid (KanCare), Oregon Health Plan, Connecticut Medicaid (HUSKY Health), BCBS Michigan, Pennsylvania Medicaid (DHS).

How do I get notified when CPT 99394 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 99394. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 99394?

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.

99394 — A preventive health check-up visit for a patient between ages 12 and 17 who is an established patient of the doctor.: Insurance Policy Changes

99394 Insurance Policy Changes

CPT 99394, in plain terms, covers A preventive health check-up visit for a patient between ages 12 and 17 who is an established patient of the doctor. CPT 99394 is referenced in 29 tracked payer policy changes from Harvard Pilgrim Health Care, New Mexico Medicaid, and 14 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 99394 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact

[Ohio] Reimbursement policy update: Screening Services with Related Evaluation and Management Services — Professional

Anthem BCBS·Effective Apr 1, 2026

Effective April 1, 2026, Anthem will update its reimbursement policy to clarify that screening services, annual gynecological exams, counseling, medical nutrition therapy, prolonged services, and visual acuity screenings cannot be billed separately when provided on the same day as preventive medicine visits (CPT 99381-99387, 99391-99397, G0402). Modifier 25 appending will not override this bundling restriction. The policy will be renamed to reflect preventive medicine services focus.

99394 Insurance Policy Changes

Reimbursement updates for preventive medicine services

Supplement 26-02: Early and Periodic Screening, Diagnostic, and Treatment EPSDT / Tot to Teen Healthcheck Updated Screening Services Requirements

26-084 Commercial Plans Will No Longer Accept Medicare-Specific G-Codes Starting April 1, 2026

[Ohio] Reimbursement policy update: Screening Services with Related Evaluation and Management Services — Professional

[New York] Reimbursement policy update: Screening Services with Related Evaluation and Management Services — Professional

[Georgia] Reimbursement policy update: Screening Services with Related Evaluation and Management Services — Professional

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

One-to-One for Healthcare - Winter Edition

All Provider Bulletin 408: Annual Behavioral Health Wellness Examinations

[Georgia] EPSDT Billing Update

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

PT 49-26: GE Modifier Clarification

Indian Health Program Rates Adjusted for Calendar Year 2026

KMAP BULLETIN: Kan Be Healthy (KBH) Allowed Provider Psychiatric APRN (09/096)

KMAP BULLETIN: Coverage for Add-on Code 99459 Pelvic Examination

Proposed Amendments to COMAR 10.09.02 Physicians'' Services

General Provider Transmittal

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

20-178 Patient Assessment Form No Longer Needed to Get Incentive

20-297 Complete the IHA within 120 Days to Help Manage Your Patient’s Health Care Needs

20-298 Complete the IHA within 120 Days to Help Manage Your Patient’s Health Care Needs

25-913 Bill Correctly for HIV Pre-exposure Prophylaxis (PrEP)

25-914 Bill Correctly for HIV Pre-exposure Prophylaxis (PrEP)

25-915 Bill Correctly for HIV Pre-exposure Prophylaxis (PrEP)

Revised: Documentation and Billing Guidelines for Services Performed by Residents

Do you have time for a Quality Minute about annual wellness visits?

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