All PlansCoverageMedium impact
Oct. 2026 billing policy updates
Priority Health·Cardiology, Radiology, Radiation Oncology +2 more·Claims & Billing
Effective date
Dec 14, 2026
We identified it
Oct 14, 2026
Summary
Priority Health updated multiple billing policies effective immediately and December 14, 2026. Two policies with December 14, 2026 effective dates require attention: Infusion Services Supplies (#041) clarifies that disposable delivery systems are non-covered, and Pelvic and Transvaginal Ultrasound (#056) adds new denials for CPT codes 76801, 76856, and 76857 when billed with 76817 or 76830 due to overlapping ultrasound services. Remaining policies represent current system setup with organizational updates to manual sections and coding guidance.
Action Required
By December 14, 2026: (1) Billing team must implement denial logic in billing system to prevent claims submission of CPT codes 76801, 76856, and 76857 when billed together with 76817 or 76830, as these combinations will be denied due to overlapping ultrasound services per Pelvic and Transvaginal Ultrasound policy #056. (2) Billing team and clinical staff must update internal coverage guidelines to reflect that disposable delivery systems are non-covered under Infusion Services Supplies policy #041, and verify claim submission and denials align with this requirement. (3) Coders and billing staff should review all remaining policy updates (Cardiology #003, Facility Billing #005, Medical Errors #172, Non-Invasive Cerebrovascular Studies #169, Pressure Reducing Support Surfaces #161, and Radiation Oncology #027) to ensure familiarity with new CPT codes, modifier requirements, and place of service guidance for accurate future submissions. Failure to implement the December 14 changes will result in claim denials and rework.