Question 1

What insurance policy changes affect CPT 99495?

Accepted Answer

There are 7 tracked policy changes affecting CPT 99495, including updates from CareFirst BlueCross BlueShield, Maryland Medicaid, New Jersey Medicaid. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Question 2

Which payers have updated policy for CPT 99495?

Accepted Answer

Payers that have issued tracked updates for CPT 99495 include: CareFirst BlueCross BlueShield, Maryland Medicaid, New Jersey Medicaid, Blue Cross of Idaho, Oregon Health Plan, Medical Mutual of Ohio.

Question 3

How do I get notified when CPT 99495 policy changes?

Accepted Answer

Create a free account at PolicyChanges.app and save a search filtered to CPT 99495. You will receive a daily digest email whenever a new policy change references this code.

Question 4

Why do payers change policies for CPT 99495?

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.

99495 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

MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Updated language CCM, VCS, CoCM, and telehealth

MAPAP113 - Billing Requirements for Rural Health Centers (RHCs) - Revised exclusions added

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

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