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PAP226 Category II CPT and SDoH ICD-10-CM Codes - Updated how charge amounts will display on remits
Effective date
Not stated in the notice
Identified
Sep 29, 2026
Summary
Blue Cross of Idaho updated PAP226 to clarify billing requirements for Category II CPT codes and Social Determinants of Health (SDoH) ICD-10-CM codes. The policy now specifies that Category II CPT codes and CPT 99499 (supplemental diagnoses) must be billed with $0.01 charge amounts (previously $0 or 1 cent), and reinforces documentation and submission requirements for SDoH Z-codes (Z55-Z65) to support HEDIS performance and care management.
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What to do
Action · 2 steps
01REQUIREMENTS: Immediately update billing system configuration to enforce $0.01 charge amounts (not $0 or 1 cent) when submitting Category II CPT codes and CPT 99499 claims to Blue Cross of Idaho.
02Billing team must: (1) modify billing software validation rules to require $0.01 entry for all Category II codes; (2) update claim submission templates and provider instructions to reflect the $0.01 requirement; (3) train billing staff that any other amounts will be processed as contractual adjustments on remits; (4) ensure providers understand that CPT 99499 can only be submitted as a secondary claim when primary claim reached maximum 12 diagnosis codes, with supplemental diagnoses supported in medical record and clinician-signed; (5) verify that SDoH Z-codes (Z55-Z65) being submitted have corresponding clinical documentation from social workers, case managers, or nurses with clinician sign-off.
If missed: Failure to comply will result in incorrect remit processing and potential claim adjustment issues.
Codes mentioned
99499Z55Z56Z57Z58Z59Z60Z61Z62Z63Z64Z65
Original notice
PAP226 Category II CPT and SDoH ICD-10-CM Codes - Updated how charge amounts will display on remits
providers.bcidaho.com · Always check the source before changing claims.
Related changes
See all Blue Cross of Idaho changes →PAP226 - Category II CPT and SDoH ICD-10 CM Codes - Language revision; clarified Category II CPT code reporting requirements.MediumNo effective date · CodingPAP226 - Category II CPT and SDoH ICD-10-CM Codes - Language revision; added supplemental diagnosis code section. Revised CPT II and SDoH sectionsMediumNo effective date · CodingOne-to-One for Healthcare - Winter EditionHighNo effective date · Medical PolicyBrowse every Blue Cross of Idaho change in the policy list