HCPCS G9038 is officially defined as "Co-management services with the following elements: new diagnosis or acute exacerbation and stabilization of existing condition; condition which may benefit from joint care planning; condition for which specialist is taking a co-management role; condition expected to last at least 3 months; comprehensive care plan established, implemented, revised or monitored in partnership with co-managing clinicians; ongoing communication and care coordination between co-managing clinicians furnishing care." HCPCS G9038 is referenced in 6 tracked payer policy changes from Independence Blue Cross, Michigan Medicaid - MDHHS, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS G9038 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Independence Blue Cross Medicare Advantage is revising bundling policies effective 10/01/2026. CPT code 99459 (pelvic exam during E/M) is now classified as not eligible for separate reimbursement and has been added to Attachment B. HCPCS codes G9037 and G9038 have been terminated and removed from Attachment C. Billing teams must stop billing these codes separately and ensure providers understand they cannot bill members for these services.
Michigan Medicaid has updated CPT and HCPCS codes effective July 1, 2025, adding new covered codes for various provider types and discontinuing several existing codes. This affects billing for Medicaid, Healthy Michigan Plan, and related programs in Michigan.
Multiple billing code updates effective July 1, 2025: 5 new immunization codes added, 4 codes deleted, 13 codes marked as non-reimbursable, new modifier requirements for off-campus institutional claims, and modifier 27 added for multiple outpatient E/M encounters.
Independence Blue Cross has updated policy 00.01.52ac effective 10/01/2026 to clarify that pelvic exams performed during E/M visits (CPT 99459) are not eligible for separate reimbursement. Additionally, six HCPCS codes (G2061, G2062, G2063, G9037, G9038, Q0239) have been terminated and removed from the bundled services list.
Independence Blue Cross Medicare Advantage is revising its bundled procedure code policy effective 10/01/2026. CPT code 99459 (pelvic exam during E/M service) is now classified as not eligible for separate reimbursement and has been added to Attachment B. Additionally, HCPCS codes G9037 and G9038 have been terminated and removed from Attachment C.
Independence Blue Cross updated policy 00.01.52ac to clarify that CPT 99459 (E/M with pelvic exam) is not eligible for separate reimbursement and cannot be billed to members. Additionally, six HCPCS codes (G2061, G2062, G2063, G9037, G9038, Q0239) have been terminated and removed from the non-reimbursable services list, effective October 1, 2026.
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