All PlansBilling CodesHigh impact
July 2026 billing policy updates
Priority Health·Sleep Medicine, Radiation Oncology, Orthopedics +4 more·Claims & Billing
Effective date
Jul 23, 2026
We identified it
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.
Action Required
By September 23, 2026: Billing team must implement the following updates across all affected service lines: (1) Update billing system configurations for PAP Devices (#020) to calculate supply limits on a rolling calendar basis instead of fixed periods; (2) Implement Radiation Oncology changes (#027) limiting CPT 77338 reimbursement to one unit per eight-week period and incorporate image fusion billing guidance in dosimetry sections; (3) Remove CPT J9271 from edit criteria for Reimbursement Requirements for Outpatient Medical Drugs (#092); (4) Update encounter forms and staff training for Modifier 25 requirements (#025) regarding new versus established patient billing; (5) For Sacroiliac Joint Injections (#114), Cervical Traction Devices (#109), and Transcutaneous Electrical Joint Stimulation Devices (#116), review coding corrections and definition updates in billing system; (6) Link Therapeutic Shoes Diabetic (#163) billing to Medical Policy 91077 for frequency/limitation guidance; (7) Update Non-invasive Vascular Studies (#097) to align with CMS-established diagnostic criteria; (8) Implement new policies for OMT (#200), Split Billing (#201), and Trauma Team Activation (#202) effective September 23, 2026. Train all billing and clinical staff on these changes. Failure to implement will result in claim delays, denials, and processing errors.