Question 1

What insurance policy changes affect CPT 99381?

Accepted Answer

There are 5 tracked policy changes affecting CPT 99381, including updates from MassHealth, Maryland Medicaid, Arizona Medicaid - AHCCCS. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Question 2

Which payers have updated policy for CPT 99381?

Accepted Answer

Payers that have issued tracked updates for CPT 99381 include: MassHealth, Maryland Medicaid, Arizona Medicaid - AHCCCS.

Question 3

How do I get notified when CPT 99381 policy changes?

Accepted Answer

Create a free account at PolicyChanges.app and save a search filtered to CPT 99381. You will receive a daily digest email whenever a new policy change references this code.

Question 4

Why do payers change policies for CPT 99381?

Accepted Answer

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.

99381 Insurance Policy Changes

All Provider Bulletin 408: Annual Behavioral Health Wellness Examinations

PT 88-25: Primary Care Investment: E&M Increases

PT 49-26: GE Modifier Clarification

PT 66-26: Federally Qualified Health Center and Rural Health Center Coding Guidelines

AHCCCS DFSM Claims Clues - January 2013