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PAP226 - Category II CPT and SDoH ICD-10-CM Codes - Language revision; added supplemental diagnosis code section. Revised CPT II and SDoH sections
Act
immediately
Effective date
Not stated in the notice
Identified
Jun 19, 2026
Summary
Blue Cross of Idaho updated PAP226 to clarify Category II CPT code reporting requirements and added a new section on supplemental diagnosis codes. Billing teams can now submit CPT code 99499 as an additional claim to report diagnosis codes (including SDoH Z codes) that couldn't be attached to the original E/M service claim due to system limitations or the 12-diagnosis maximum.
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What to do
immediately · 7 steps
01Billing team must update claim submission processes to recognize CPT code 99499 as a valid supplemental diagnosis reporting mechanism.
02Train billers that 99499 can only be submitted as an additional claim when the primary claim was an E/M service and already contains 12 diagnosis codes.
03Ensure 99499 claims are submitted with $0.01 charge amount, same member name, same rendering/billing provider, and same date of service as the primary claim.
04Configure billing system to allow multiple units of 99499 on the same date of service but prohibit other CPT codes on the 99499-only claim.
05For vendor-administered prospective health assessment programs, allow modifier SC only on 99499.
06Ensure all supplemental diagnosis codes (including Z codes Z55-Z65 for Social Determinants of Health) are documented and supported in the medical record before submission.
07Update encounter templates and billing workflows to facilitate collection and documentation of SDoH codes.
If missed: Failure to follow these requirements will result in claim denials or processing delays.
Codes mentioned
99499Z55Z56Z57Z58Z59Z60Z61Z62Z63Z64Z65
Original notice
PAP226 - Category II CPT and SDoH ICD-10-CM Codes - Language revision; added supplemental diagnosis code section. Revised CPT II and SDoH sections
providers.bcidaho.com · Always check the source before changing claims.
Related changes
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