Medical Policy Updates August 5, 2026

By August 5, 2026: (1) ALLERGEN TESTING: Billing team must add CPT 95004 to system and update coverage to limit reimbursement to 40 allergen-specific antibodies per year. New rule: deny claims for specific IgE testing performed same day as skin prick testing (add edits to billing system). (2) CARDIOVASCULAR RISK ASSESSMENT: Update system to add CPT 83876; modify coverage to expand screening age criteria (remove age 18 restriction); change frequency from every 4 years to every 5 years for standard risk; change CC1 c) iii) to allow testing every 3-12 months (not annually) for high-risk patients; add code restriction (no more than once every 4 weeks) to CC2; remove CRP testing and add myeloperoxidase to non-covered codes. (3) STI TESTING (AHS-G2157): Remove CPT codes 86704, 86706, 87340, G0499 from system; add CPT codes 87140, 87270, 87285, 87320, 87660, 87810. Update coverage rules: integrate prenatal STI screening into this policy; require 3-month minimum for gonorrhea test-of-cure (TOC); deny treponemal testing for patients with current or past syphilis diagnosis; deny PCR, NAAT, and antigen testing for syphilis; deny culture, antibody, and antigen testing for chlamydia/LGV; add Trichomonas vaginalis coverage under this policy (moved from vaginitis policy). (4) VAGINITIS TESTING (M2057): Remove CPT 87660 from individual testing coverage; require multi-pathogen panel testing for Trichomonas (deny individual Trichomonas testing); update Candida testing requirement to NAAT (nucleic acid amplification testing), not direct probe. (5) ESOPHAGEAL PATHOLOGY: Remove CPT codes 88112, 88160, 88305, 88312; update coverage to include repotrectinib therapy indication; update genetic testing to specify NTRK1/2/3 gene fusion; replace BarreGEN test with TissueCypher® Barrett's Esophagus Assay in non-covered section. (6) COLORECTAL CANCER SCREENING: Archive old policy B0001 and implement new policy AHS-G2181 with integrated criteria; verify coverage criteria are loaded in system. (7) All billing software rules must be updated by affected date; providers must be notified of coverage/non-coverage changes via EMR updates and encounter form changes to prevent inappropriate billing. Failure to comply will result in claim denials and potential recoupment.