What insurance policy changes affect code O86?

There are 2 tracked policy changes affecting code O86, including updates from Medi-Cal. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code O86?

Payers that have issued tracked updates for code O86 include: Medi-Cal.

How do I get notified when code O86 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code O86. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for code O86?

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.

PAYER POLICY CHANGES

O86 Insurance Policy Changes

code O86 is referenced in 2 tracked payer policy changes from Medi-Cal. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code O86 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Only a small number of policies match this filter. Check back as coverage expands.

Medi-Cal · Effective Nov 1, 2026High impact
Reminder: Obstetrical Providers Encouraged to Use E&M Codes with Modifier TH
Effective November 1, 2026, Medi-Cal encourages obstetrical providers to submit claims for prenatal and postpartum care using E&M codes (99204, 99205, 99213, 99214, 99215) with modifier TH instead of global obstetric codes. This change anticipates the AMA's January 1, 2027 replacement of the global obstetric CPT code structure, allowing separate identification of antepartum, labor, delivery, and postpartum services. Claims must include appropriate gestational age ICD-10 codes (Z3A.00-49 for prenatal) or postpartum codes (O86-O92, Z39.0-2, F53.0-1).
Medi-Cal · Effective Nov 1, 2026High impact
Obstetrical Providers Encouraged to Use E&M Codes with Modifier TH
Effective November 1, 2026, Medi-Cal encourages obstetrical providers to bill prenatal and postpartum care using E&M codes (99204, 99205, 99213, 99214, 99215) with modifier TH instead of global obstetric codes. This change aligns with upcoming AMA coding framework changes (effective January 1, 2027) that separately identify antepartum, labor, delivery, and postpartum services. Prenatal claims must include gestational age codes (Z3A.00-Z3A.49); postpartum claims must include relevant postpartum diagnosis codes (O86-O92, Z39.0-Z39.2, or F53.0-F53.1).

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Reminder: Obstetrical Providers Encouraged to Use E&M Codes with Modifier TH

Obstetrical Providers Encouraged to Use E&M Codes with Modifier TH

What insurance policy changes affect code O86?

Which payers have updated policy for code O86?

How do I get notified when code O86 policy changes?

Why do payers change policies for code O86?