Question 1

What insurance policy changes affect CPT 99407?

Accepted Answer

There are 7 tracked policy changes affecting CPT 99407, including updates from Pennsylvania Medicaid (DHS), Aetna, Connecticut Medicaid (HUSKY Health). Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Question 2

Which payers have updated policy for CPT 99407?

Accepted Answer

Payers that have issued tracked updates for CPT 99407 include: Pennsylvania Medicaid (DHS), Aetna, Connecticut Medicaid (HUSKY Health), Blue Cross of Idaho, Oregon Health Plan.

Question 3

How do I get notified when CPT 99407 policy changes?

Accepted Answer

Create a free account at PolicyChanges.app and save a search filtered to CPT 99407. You will receive a daily digest email whenever a new policy change references this code.

Question 4

Why do payers change policies for CPT 99407?

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.

99407 Insurance Policy Changes

MAB2026080601

Benralizumab (Fasenra) (CPB 0925, reviewed 2025-12-23)

2025.33 - Provider Bulletin - New Coding & Reimbursement for SBIRT Services

MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Updated language CCM, VCS, CoCM, and telehealth

MAPAP113 - Billing Requirements for Rural Health Centers (RHCs) - Revised exclusions added

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

Coverage for Screening, Brief Intervention and Referral to Treatment pdf