What insurance policy changes affect CPT 98000?

There are 10 tracked policy changes affecting CPT 98000, including updates from MassHealth, Highmark, Florida Blue. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 98000?

Payers that have issued tracked updates for CPT 98000 include: MassHealth, Highmark, Florida Blue, CareSource, Connecticut Medicaid (HUSKY Health), Indiana Medicaid (IHCP), Alaska Medicaid.

How do I get notified when CPT 98000 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 98000. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 98000?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

98000 — A synchronized audio-video telehealth visit for a new patient lasting around 15 minutes.: Insurance Policy Changes

98000 Insurance Policy Changes

CPT 98000, in plain terms, covers A synchronized audio-video telehealth visit for a new patient lasting around 15 minutes. CPT 98000 is referenced in 10 tracked payer policy changes from MassHealth, Highmark, and 5 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 98000 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact

All Provider Bulletin 419: Transition to Separate Reporting of Maternity Care Services

MassHealth·Effective Sep 1, 2026

Effective September 1, 2026, MassHealth requires providers to transition maternity care billing for new patients to evaluation and management (E/M) codes with TH modifier instead of global maternity CPT codes (59425, 59426, etc.). Existing patients with first prenatal visits before September 1, 2026 continue using legacy codes; new patients after that date must use appropriate E/M codes (99202-99205 for new patients, 99211-99215 for established patients, plus telemedicine codes) based on medical decision-making level.

98000 Insurance Policy Changes

All Provider Bulletin 419: Transition to Separate Reporting of Maternity Care Services

Highmark’s Telehealth Policy Will Be Updated on Sept. 1

Important Policy Update: Telemedicine Evaluation and Management Services

[Ohio] Telehealth: Updates to the OAC Rule Effective Date January 1, 2026

[Ohio] Telehealth: Updates to the OAC Rule

Hospital Monthly Important Message - 08.18.2025

BT202592: IHCP updates CCBHC encounter codes

BT202593: IHCP updates FQHC and RHC encounter codes

Hospital Monthly Important Message - 09.15.2025

February 2025 Town Hall FAQ