CommercialBilling CodesHigh impact
Reimbursement Policy Updates
EmblemHealth·Provider News
Effective date
Jan 1, 2023
We identified it
Jun 20, 2026
Summary
EmblemHealth and ConnectiCare updated their billing guidelines with new policies effective January 1, 2023, including requirements to convert HCPCS codes to CPT codes when possible, new foot care services policy, modifier payment reductions, and stricter date of service documentation requirements. Several existing policies were also revised with new coding edits and updated preventive care lists.
Action Required
Immediately: Convert all HCPCS codes to applicable CPT codes before submitting claims to EmblemHealth and ConnectiCare when possible. Update billing system to account for 10% payment reduction on claims with modifiers FX and FY. Implement new coding edits for modifier JW (drug amount discarded). Ensure all claims have properly documented dates of service within correct calendar ranges and format to prevent denials under the new From/To Date Span Policy. Review updated foot care services billing requirements for Commercial, Medicare, and Medicaid plans.