What insurance policy changes affect CPT 99403?

There are 11 tracked policy changes affecting CPT 99403, including updates from CareFirst BlueCross BlueShield, Maryland Medicaid, New Jersey Medicaid. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 99403?

Payers that have issued tracked updates for CPT 99403 include: CareFirst BlueCross BlueShield, Maryland Medicaid, New Jersey Medicaid, Blue Cross & Blue Shield of Mississippi, Nevada Medicaid, Highmark, Oregon Health Plan, Health Net, Medical Mutual of Ohio.

How do I get notified when CPT 99403 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 99403. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 99403?

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.

99403 — A preventive health consultation where a doctor discusses wellness and disease prevention with you, lasting about 45 minutes.: Insurance Policy Changes

99403 Insurance Policy Changes

CPT 99403, in plain terms, covers A preventive health consultation where a doctor discusses wellness and disease prevention with you, lasting about 45 minutes. CPT 99403 is referenced in 11 tracked payer policy changes from CareFirst BlueCross BlueShield, Maryland Medicaid, and 7 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 99403 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Medium impact

Delaware Doula Services Mandate

Highmark·Effective Jan 1, 2026

Effective January 1, 2026, Delaware insurers must cover doula services for pregnant and birthing individuals under individual, small group, and large group fully insured policies. Coverage includes prenatal visits, postpartum visits, labor/birth attendance, and additional visits as clinically recommended. Doulas must be certified per Delaware DMMA requirements, and billing uses HCPCS codes T1032 and T1033, or preventive counseling codes 99401-99403 with diagnosis code Z391.

99403 Insurance Policy Changes

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

Preventive Health Services

Attention Federally Qualified Health Center (FQHC) Providers: Clarification of Pharmacist Codes Billable for Encounters

Delaware Doula Services Mandate

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

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)

Best Practices and Coding to Accurately Capture Follow-Up Visits for TRC and FMC HEDIS Measures