March 27, 2025
Clinical Payment and Coding Policies describe payment rules and methodologies for Current Procedural Terminology (CPT®) codes, Healthcare Common Procedure Coding System and ICD-10 coding for claims submitted as covered services. This information is a resource for our payment policies. It’s not intended to address all reimbursement-related issues.
We regularly add and modify clinical payment and coding policy positions as part of our ongoing policy review process.
The following policy code list was updated:
- CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services policy code list, effective June 15, 2025
The following policies were updated:
- CPCP005 Home Health Care Policy, effective March 21, 2025
- CPCP006 Preventive Services Policy, effective April 1, 2025
- CPCP033 Telemedicine and Telehealth/Virtual Health Care Services, effective Jan. 1, 2025
The following policies are new:
- CPCP043 Lactation Support Services, effective June 26, 2025
View the revised policies.
CPT copyright 2024 American Medical Association. All rights reserved. CPT is a registered trademark of the AMA.
The information provided does not constitute coding or legal advice. Physicians and other health care providers should use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment, and to submit claims using the most appropriate code(s) based upon the medical record documentation, coding guidelines and reference materials.