What insurance policy changes affect CPT 99402?

There are 15 tracked policy changes affecting CPT 99402, including updates from BlueCross BlueShield of South Carolina, Harvard Pilgrim Health Care, CareFirst BlueCross BlueShield. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 99402?

Payers that have issued tracked updates for CPT 99402 include: BlueCross BlueShield of South Carolina, Harvard Pilgrim Health Care, CareFirst BlueCross BlueShield, Maryland Medicaid, New Jersey Medicaid, Blue Cross & Blue Shield of Mississippi, Nevada Medicaid, Highmark, Oregon Health Plan, Health Net, Medical Mutual of Ohio.

How do I get notified when CPT 99402 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 99402. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 99402?

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.

99402 — A doctor talks with you for about 30 minutes to discuss ways to stay healthy and prevent future medical problems.: Insurance Policy Changes

99402 Insurance Policy Changes

CPT 99402, in plain terms, covers A doctor talks with you for about 30 minutes to discuss ways to stay healthy and prevent future medical problems. CPT 99402 is referenced in 15 tracked payer policy changes from BlueCross BlueShield of South Carolina, Harvard Pilgrim Health Care, and 9 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 99402 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact

2026 May Medical Policy Updates

BlueCross BlueShield of South Carolina·Effective May 29, 2026

BlueCross BlueShield of South Carolina and BlueChoice HealthPlan released 40 medical policy updates effective May 29, 2026. Key billing changes include: (1) CPT codes 77062 and 77063 added for breast cancer screening; (2) HCPCS code S9943 replaces CPT codes 99401/99402 for breastfeeding counseling; (3) Seven new E-series codes (E0658, E0678-E0683) added for compression pumps; (4) CPT code 0423U added for pharmacogenetic testing; (5) One new policy (CAM 404) for Transcranial Magnetic Stimulation; (6) CAM 80133 expanded to include HDR temporary prostate brachytherapy as salvage therapy; (7) CAM 80160 reorganized criteria for ECMO; (8) CAM 90328 expanded to include epithelium-on corneal collagen products.

99402 Insurance Policy Changes

2026 May Medical Policy Updates

Billing updates for mental health centers

Maryland Medicaid enhanced reimbursement rates for eligible primary care providers, effective August 1, 2025

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

Newsletter Vol. 35, No.08

Preventive Health Services

2026 May Medical Policy Updates

PT 78-26: Billing Requirement Update for Community Violence Prevention Services

Attention Federally Qualified Health Center (FQHC) Providers: Clarification of Pharmacist Codes Billable for Encounters

Delaware Doula Services Mandate

Notice of intent – OHA will amend the Medicaid State Plan to increase fee-for-service primary care rates.

25-913 Bill Correctly for HIV Pre-exposure Prophylaxis (PrEP)

25-914 Bill Correctly for HIV Pre-exposure Prophylaxis (PrEP)

25-915 Bill Correctly for HIV Pre-exposure Prophylaxis (PrEP)

Best Practices and Coding to Accurately Capture Follow-Up Visits for TRC and FMC HEDIS Measures