All PlansReimbursementHigh impact
Provider News - September 2025
Security Health Plan·Provider News
Effective date
Nov 1, 2025
We identified it
Jun 20, 2026
Summary
Security Health Plan has made multiple changes including modifier 50 billing restrictions for ASCs, revised modifier reimbursements starting Nov 1, 2025, and discontinuation of Zepbound/Wegovy coverage starting Jan 1, 2026. Peer-to-peer review timing has also been updated.
Action Required
By Nov 1, 2025: Billing team must update system to reflect revised modifier reimbursement amounts per Security Health Plan standards. Immediately: ASCs must stop using modifier 50 for bilateral procedures on all Security Health Plan claims. By Jan 1, 2026: Update system to reject Zepbound and Wegovy prior authorizations as these will no longer be covered. By Sept 1, 2025: Update peer-to-peer review processes - providers now have 24 hours/next business day for urgent requests and 14 business days for non-urgent requests after determination.