ExchangeReimbursementHigh impact
Provider Notification: New Payment Policy: CC.PP.061 (Non-obstetrical and Obstetrical Transabdominal and Transvaginal Ultrasounds), CC.PP.067 (Renal Hemodialysis), and CC.PP.068 (Multiple Procedure Payment Reduction for Therapeutic Service)
Ambetter·IN · Radiology, Nephrology·Claims & Billing
Effective date
Aug 5, 2026
We identified it
Aug 26, 2026
Summary
Managed Health Services (MHS) implemented three new payment policies effective August 5, 2026: CC.PP.061 applies a 50% reduction to abdominal ultrasounds when performed with transvaginal ultrasounds on the same day; CC.PP.067 limits hemodialysis reimbursement to three treatments per calendar week with automatic denial of excess units; and CC.PP.068 applies a 90% payment reduction to all therapeutic procedures after the highest-cost procedure when multiple 'always therapy' procedures with MPI of 5 are billed on the same day by the same provider or group.
Action Required
By August 5, 2026: (1) Billing team must update billing software to automatically apply 50% reduction to abdominal ultrasound CPT codes (76700, 76705) when billed with transvaginal ultrasound (76830) on the same date of service. (2) Configure system to block and auto-deny any hemodialysis claims exceeding three treatments per calendar week (Sunday-Saturday); implement warning alerts at claim submission. (3) For therapeutic procedures with MPI of 5, program system to identify when multiple procedures are billed same-day by same provider/group and automatically reduce payment to 90% for all procedures except the highest-cost one. (4) Billing team and vendors must validate current workflows against these rules and update claim scrubbing logic accordingly. (5) Distribute updated guidance to all providers and internal staff performing medical billing. Failure to implement these changes will result in claims being processed incorrectly, overpayments being recouped, or denials for out-of-frequency treatments.