All PlansBilling CodesMedium impact
PAP226 - Category II CPT and SDoH ICD-10-CM Codes - Language revision; added supplemental diagnosis code section. Revised CPT II and SDoH sections
Blue Cross of Idaho·ID·Coding
Effective date
Aug 1, 2025
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho updated PAP226 to clarify billing requirements for Category II CPT codes and Social Determinants of Health (SDoH) Z codes, and added a new section allowing CPT 99499 to submit supplemental diagnosis codes that couldn't be included on original E/M claims due to system limitations.
Action Required
Immediately: Update billing system to allow CPT 99499 for supplemental diagnosis codes with $0.01 charge amount. Train billing team to use 99499 only when primary E/M claim already has maximum 12 diagnosis codes and only for face-to-face visits. Configure system to prevent other CPT codes on 99499 claims and ensure same date of service, provider, and member information as primary claim.