ExchangeBilling CodesMedium impact
New Payment Policy: Problem-Oriented Visits with Surgical Procedure (CC.PP.052) & Problem-Oriented Visits with Preventative Visits (CC.PP.057)
Ambetter·IN·Claims & Billing
Effective date
Sep 19, 2026
We identified it
Sep 12, 2026
Summary
Ambetter from MHS Indiana has announced new payment policies (CC.PP.052 and CC.PP.057) governing reimbursement for problem-oriented visits combined with surgical procedures and preventative visits. The policy becomes effective 9/19/2026 and requires billing teams to validate that their coding and billing workflows align with the updated guidance to ensure compliant claims processing.
Action Required
By 9/19/2026: Billing team must review the full payment policy text at the Clinical Payment Policies link for Ambetter from MHS Indiana to understand specific coding and bundling rules for CC.PP.052 (Problem-Oriented Visits with Surgical Procedure) and CC.PP.057 (Problem-Oriented Visits with Preventative Visits). Validate current billing and coding workflows in the billing system to ensure compliance. Communicate policy details to providers and any external billing vendors. Update encounter documentation templates if needed to support proper code selection. Monitor claims submitted on or after 9/19/2026 for any denials related to these visit types. Contact MHS at (877) 647-4848 (Monday–Friday, 8:00 a.m.–8:00 p.m. EST) if clarification is needed before the effective date.