All PlansBilling CodesHigh impact
June 2026 billing policy updates
Priority Health·Claims & Billing
Effective date
Aug 25, 2026
We identified it
Jun 23, 2026
Summary
Priority Health updated multiple billing policies with key changes including new modifier requirements for surgical assistants, removal of age requirements for balloon sinus procedures, and updated Medicare Annual Wellness Visit billing to once every 12 months instead of once per calendar year.
Action Required
By August 25, 2026: Billing team must update system rules for G0438 and G0439 Medicare Annual Wellness Visit codes to allow billing only once every 12 months instead of once per calendar year. Update encounter forms to reflect new modifier requirements for surgical assistant procedures (modifiers 80/81/82 and AS). Add anatomical modifiers to U54 procedure codes or claims will be denied. Stop billing surgical dressings separately for physician office visits (POS 11) as they are now considered part of global surgical service.