Question 1

What insurance policy changes affect CPT 99460?

Accepted Answer

There are 3 tracked policy changes affecting CPT 99460, including updates from New Mexico Medicaid, Oregon Health Plan, Pennsylvania Medicaid (DHS). Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Question 2

Which payers have updated policy for CPT 99460?

Accepted Answer

Payers that have issued tracked updates for CPT 99460 include: New Mexico Medicaid, Oregon Health Plan, Pennsylvania Medicaid (DHS).

Question 3

How do I get notified when CPT 99460 policy changes?

Accepted Answer

Create a free account at PolicyChanges.app and save a search filtered to CPT 99460. You will receive a daily digest email whenever a new policy change references this code.

Question 4

Why do payers change policies for CPT 99460?

Accepted Answer

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.

99460 Insurance Policy Changes

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

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

MAB2025052101