What insurance policy changes affect CPT 99397?

There are 22 tracked policy changes affecting CPT 99397, including updates from Harvard Pilgrim Health Care, Health Net, Anthem BCBS. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 99397?

Payers that have issued tracked updates for CPT 99397 include: Harvard Pilgrim Health Care, Health Net, Anthem BCBS, Maryland Medicaid, Blue Cross of Idaho, MassHealth, CareFirst BlueCross BlueShield, New Jersey Medicaid, Kansas Medicaid (KanCare), Oregon Health Plan, Connecticut Medicaid (HUSKY Health), BCBS Michigan, Florida Blue.

How do I get notified when CPT 99397 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 99397. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 99397?

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.

99397 — A yearly health checkup visit for an established patient who is 65 years old or older.: Insurance Policy Changes

99397 Insurance Policy Changes

CPT 99397, in plain terms, covers A yearly health checkup visit for an established patient who is 65 years old or older. CPT 99397 is referenced in 22 tracked payer policy changes from Harvard Pilgrim Health Care, Health Net, and 11 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 99397 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.

99397 Insurance Policy Changes

Reimbursement updates for preventive medicine services

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

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

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

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?

Coding Newsletter - Annual Wellness Visit