Special Alert June 2026 - UPDATE Part 2 - Alert for 6.1 and 7.1 Coding and Reimbursement Policy Changes

IMMEDIATE ACTIONS REQUIRED: By May 31, 2026: (1) Billing team must update claim submission software to deny facility-billed critical care services (99291, 99292) when rendered in the ED with discharge disposition 'to home' (status code 01). Communicate to ED providers that appropriate ED E/M levels should be reported instead. (2) Implement system edit to require anatomical modifiers (RT, LT, E1-E4, F1-F9, T1-T9, LC, RC) on all bilateral-eligible surgical procedure codes (CPT 10000-69999) and deny claims with missing, incorrect, or non-specific modifiers (59, XS). Notify surgical staff and providers to verify anatomical site/laterality on all operative reports before billing. (3) For commercial plans only: Update anesthesia reimbursement calculation to exclude additional unit payments for physical status modifiers P3, P4, P5 effective June 1, 2026. Anesthesia providers may continue documenting these modifiers for clinical purposes, but inform them no additional reimbursement will be made. (4) Immediately cease applying the rescinded inpatient sepsis DRG length-of-stay edit; remove this edit from all billing logic. Update provider communications to reflect this change. CONSEQUENCES: Claims submitted without these corrections will be denied at the line level, resulting in lost revenue and claim resubmission delays.