What insurance policy changes affect CPT 99498?

There are 9 tracked policy changes affecting CPT 99498, 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 99498?

Payers that have issued tracked updates for CPT 99498 include: CareFirst BlueCross BlueShield, Maryland Medicaid, New Jersey Medicaid, Highmark, Blue Cross of Idaho, Oregon Health Plan, Medical Mutual of Ohio, Florida Blue.

How do I get notified when CPT 99498 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 99498. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 99498?

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.

99498 — A doctor spends an extra half hour helping you create or update detailed plans for managing complex health conditions.: Insurance Policy Changes

99498 Insurance Policy Changes

CPT 99498, in plain terms, covers A doctor spends an extra half hour helping you create or update detailed plans for managing complex health conditions. CPT 99498 is referenced in 9 tracked payer policy changes from CareFirst BlueCross BlueShield, Maryland Medicaid, and 6 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 99498 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Medium impact

Guidelines for Coding a Wellness Visit and Sick Visit Occurring on the Same Day

Medical Mutual of Ohio·Identified Jun 20, 2026

Medical Mutual updated guidelines for billing both wellness visits and sick visits on the same day for Medicare Advantage patients. When treating acute problems during an annual wellness visit, providers can bill both the wellness code (G0402, G0438, or G0439) and a problem-oriented visit code (99202-99215) but must add modifier 25 to the sick visit code only.

99498 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

New and Updated Reimbursement Policies – May 2026

New and Updated Reimbursement Policies – April 2026

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.

Guidelines for Coding a Wellness Visit and Sick Visit Occurring on the Same Day

Coding Newsletter - Annual Wellness Visit