Sept. 2026 billing policy updates
Priority Health issued 11 billing policy updates effective immediately and two policies with delayed implementation on Nov 16, 2026. Key changes include: (1) new CGM billing code requirements with denials for non-compliant codes, (2) removal of medical necessity criteria and frequency limits for certain procedures, (3) clarifications on provider-based billing and included supplies, and (4) updated colorectal cancer screening guidance. Billing teams must immediately implement software changes for CGM codes and provider-based billing rules, with additional updates required before November 16, 2026.