CommercialReimbursementHigh impact
Reimbursement Policy Updates
EmblemHealth·NY, CT · Podiatry, Radiology, Allergy & Immunology +2 more·Provider News
Effective date
Jan 1, 2023
We identified it
Jun 20, 2026
Summary
EmblemHealth and ConnectiCare introduced multiple policy updates effective January 1, 2023, including new foot care reimbursement policies, a 10% payment reduction for traditional x-ray modifiers FX and FY, updated COVID-19 vaccine codes, and elimination of consultation codes for GHI PPO City of New York Plans. Several preventive care guidelines were also updated to align with CMS requirements.
Action Required
Immediately: Stop billing consultation codes 99241-99255 for GHI PPO City of New York Plans - use non-consultative E&M codes instead. Update billing system to apply 10% payment reduction for modifier FX and FY claims. Review and implement new foot care services reimbursement policy for Commercial, Medicare, and Medicaid. Update COVID-19 vaccine billing codes per revision history. Billing team must verify preventive care coverage changes for Connecticut breast/ovarian cancer mandates.