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Chelation therapy policy and billing updates effective Sept. 7
Priority Health·Cardiology, Internal Medicine, Nephrology +1 more·Claims & Billing
Effective date
Sep 7, 2026
We identified it
Jul 7, 2026
Summary
Priority Health has expanded the diagnosis codes eligible for chelation therapy coverage under medical policy #91077 and implemented automated claim edits. Professional claims edits are already active; facility claims edits will activate September 7, 2026. Claims submitted without compliant diagnosis codes will be denied.
Action Required
By September 7, 2026: Billing team must verify that all chelation therapy facility claims include diagnosis codes aligned with medical policy #91077. Review billing policy #159 for specific requirements. Coordinate with providers to ensure proper diagnosis code documentation on encounter forms and claims. Update billing system validation rules if necessary to prevent denials. Claims submitted without appropriate diagnoses will be automatically denied by Priority Health system edits.