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Priority HealthAll Plans · Billing Codes · Claims & Billing · Sleep Medicine, Radiation Oncology, Orthopedics +4 moreHigh impact

July 2026 billing policy updates

Act
by Sep 23, 2026
Effective date
Jul 23, 2026
Identified
Jul 21, 2026

Summary

Priority Health published 15 billing policy updates effective July 23 and September 23, 2026, affecting multiple service lines including OMT, DME, oncology, sleep medicine, and vascular studies. Key changes include clarifications on modifier usage, supply limit calculations, coding guidelines, and medical necessity criteria. Billing teams must review and implement updates across multiple service categories to ensure accurate claim submission.

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What to do

by Sep 23, 2026 · 10 steps
01Billing team must implement the following updates across all affected service lines.
02Update billing system configurations for PAP Devices (#020) to calculate supply limits on a rolling calendar basis instead of fixed periods.
03Implement Radiation Oncology changes (#027) limiting CPT 77338 reimbursement to one unit per eight-week period and incorporate image fusion billing guidance in dosimetry sections.
04Remove CPT J9271 from edit criteria for Reimbursement Requirements for Outpatient Medical Drugs (#092).
05Update encounter forms and staff training for Modifier 25 requirements (#025) regarding new versus established patient billing.
06For Sacroiliac Joint Injections (#114), Cervical Traction Devices (#109), and Transcutaneous Electrical Joint Stimulation Devices (#116), review coding corrections and definition updates in billing system.
07Link Therapeutic Shoes Diabetic (#163) billing to Medical Policy 91077 for frequency/limitation guidance.
08Update Non-invasive Vascular Studies (#097) to align with CMS-established diagnostic criteria.
09Implement new policies for OMT (#200), Split Billing (#201), and Trauma Team Activation (#202) effective September 23, 2026.
10Train all billing and clinical staff on these changes.
If missed: Failure to implement will result in claim delays, denials, and processing errors.

Codes mentioned

77338A4459A4453J9271992139921499215

Original notice

July 2026 billing policy updates
priorityhealth.com · Always check the source before changing claims.
View original ↗

Related changes

See all Priority Health changes →
August 2026 billing policy updatesMediumEffective Aug 20, 2026 · Claims & BillingBrowse every Priority Health change in the policy list

Related policy hubs

Priority Health policiesSleep MedicineRadiation OncologyOrthopedicsPain ManagementOphthalmologyPulmonologyVascular SurgeryCode 77338Code A4459Code A4453Code J9271Code 99213Code 99214Code 99215

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