Obsolete and Unreliable Tests and Procedures (CPB 0438, reviewed 2026-07-16)

By 2026-08-16 (30 days prior to effective date): (1) Billing team must update all billing software and claim submission rules to deny claims containing the 48 listed CPT/HCPCS codes when billed with the corresponding ICD-10 diagnosis codes (e.g., CPT 82150 with ICD-10 codes for LE cell tests, CPT 55705 with prostate biopsy indications). (2) Generate a report of all claims paid in the past 24 months matching these code-diagnosis combinations and submit for refund processing. (3) Providers must receive written notification of non-covered procedures with specific code listings; add alert logic to EMR/practice management system to flag these combinations during encounter entry. (4) Front desk and revenue cycle staff must be trained on the policy and understand that claims for these procedures will be systematically denied and may require patient notification for out-of-pocket responsibility. (5) Effective 2026-07-16, any claim submitted with these code combinations will be denied automatically; providers must use updated procedure codes when modern alternatives exist (e.g., transrectal ultrasound-guided core needle biopsy instead of incisional prostate biopsy).