Z76.2 Insurance Policy Changes

ICD-10 Z76.2 is officially defined as "Encounter for health supervision and care of other healthy infant and child." code Z76.2 is referenced in 4 tracked payer policy changes from New Mexico Medicaid, Blue Cross and Blue Shield of Louisiana, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code Z76.2 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

New Mexico Medicaid · Identified Jun 21, 2026High impact
Supplement 26-02: Early and Periodic Screening, Diagnostic, and Treatment EPSDT / Tot to Teen Healthcheck Updated Screening Services Requirements
New Mexico Medicaid's EPSDT (Tot to Teen Healthcheck) well-child visit requirements call for a comprehensive, age-appropriate visit that includes medical history, nutrition screening, measurements, vision and hearing screening, developmental and behavioral screening, a physical examination, oral evaluation, immunizations per the AAP schedule, and anticipatory guidance. Children entering state custody must receive a comprehensive well-child visit within 30 days of entry, and all Medicaid-enrolled children must receive a blood lead level screening test at 12 and 24 months. Maternal depression screening during infant well-child visits is reimbursable under the infant's Medicaid ID.
Blue Cross and Blue Shield of Louisiana · Identified Jun 20, 2026Medium impact
Network News - 3rd Quarter 2022
Blue Cross and Blue Shield of Louisiana added HCPCS codes A9596, A9601, C9094, C9095, C9096, C9097, J0739, J1306, J1551, J2356, J2779, J2998, J3299, J9331, J9332, Q4259, Q4260 and Q4261 to its claims system effective July 1, 2022. For dates of service on and after August 15, 2022, the COVID-19 treatment bebtelovimab is reimbursed when billed with Modifier UC, which identifies the medication as commercially purchased, and the same administration codes are used for commercially purchased and government-supplied medication. Updated professional allowable charges for flu vaccination codes take effect for dates of service on and after November 1, 2022, and the new charges can be viewed in the Professional Provider Allowable Charges Search tool in iLinkBlue. FEP requires prior authorization for admission to residential treatment centers, and an administrative denial results if prior authorization is not obtained or the member is not enrolled in New Directions care management.
Health Net · Identified Jun 20, 2026Medium impact
20-552 Earn Incentives through the Prop 56 VBP Program
Health Net's Prop 56 Value-Based Payment (VBP) program pays add-on payments to Medi-Cal providers in Fresno, Kings and Madera counties for meeting specific measures in prenatal and postpartum care, early childhood care, chronic disease management and behavioral health integration. Payments apply to services performed on or after July 1, 2019, when submitted as a clean claim or encounter within one year from the date of service with a qualifying CPT and/or ICD-10 code. Payment amounts are higher for at-risk members, for example $70 for a prenatal care visit and $105 for an at-risk prenatal care visit, and $80 for diabetes care and $120 for at-risk diabetes care.
Health Net · Identified Jun 20, 2026Medium impact
20-554 Earn Incentives through the Prop 56 VBP Program
Health Net's Prop 56 Value-Based Payment (VBP) program pays add-on payments to Medi-Cal providers in Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus and Tulare counties for meeting specific measures in prenatal and postpartum care, early childhood care, chronic disease management and behavioral health integration. Payments apply to services performed on or after July 1, 2019, when submitted as a clean claim or encounter within one year from the date of service with a qualifying CPT and/or ICD-10 code. Payment amounts are higher for at-risk members, for example $70 for a prenatal care visit and $105 for an at-risk prenatal care visit, and $80 for diabetes care and $120 for at-risk diabetes care.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code Z76.2?

There are 4 tracked policy changes affecting code Z76.2, including updates from New Mexico Medicaid, Blue Cross and Blue Shield of Louisiana, Health Net. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code Z76.2?

Payers that have issued tracked updates for code Z76.2 include: New Mexico Medicaid, Blue Cross and Blue Shield of Louisiana, Health Net.

How do I get notified when code Z76.2 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code Z76.2. 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 Z76.2?

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.

All billing codes J3590 C9399 J3490 99215 99213 99202

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Supplement 26-02: Early and Periodic Screening, Diagnostic, and Treatment EPSDT / Tot to Teen Healthcheck Updated Screening Services Requirements

Network News - 3rd Quarter 2022

20-552 Earn Incentives through the Prop 56 VBP Program

20-554 Earn Incentives through the Prop 56 VBP Program

What insurance policy changes affect code Z76.2?

Which payers have updated policy for code Z76.2?

How do I get notified when code Z76.2 policy changes?

Why do payers change policies for code Z76.2?