Clinical Payment and Coding Policy Updates

Sept. 23, 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 policies were updated:  

  • CPCP001 Observation Services Policy, effective Dec. 22, 2025
  • CPCP006 Preventive Services, effective Oct. 1, 2025
  • CPCP021 Laboratory Panel Billing, effective Sept. 22, 2025
  • CPCP026 Therapeutic, Prophylactic, Diagnostic, Injection and Infusion Administration Coding, effective Sept. 26, 2025
  • CPCP028 Non-Reimbursable EIU Services Code List, effective Sept. 15, 2025
  • CPCP033 Telemedicine and Telehealth/Virtual Health Care Services Policy, effective Sept. 26, 2025
  • CPCP051 Psychiatry/Psychotherapy Services- Professional Provider, effective Dec. 22, 2025
  • CPCPLAB001 Flow Cytometry, effective Jan. 1, 2026
  • CPCPLAB002 Cervical Cancer Screening, effective Jan. 1, 2026 
  • CPCPLAB003 Vitamin D Testing, effective Jan. 1, 2026
  • CPCPLAB004 Diabetes Mellitus Testing, effective Jan. 1, 2026
  • CPCPLAB005 Prostate Biopsy Specimen Analysis, effective Jan. 1, 2026 
  • CPCPLAB006 Prostate Specific Antigen (PSA) Testing, effective Jan. 1, 2026 
  • CPCPLAB008 Diagnostic Testing of Iron Homeostasis and Metabolism, effective Jan. 1, 2026
  • CPCPLAB009 Testosterone, effective Jan. 1, 2026 
  • CPCPLAB010 Vitamin B12 and Methylmalonic Acid Testing, effective Jan. 1, 2026
  • CPCPLAB011 Biomarker Testing for Autoimmune Rheumatic Disease, effective Jan. 1, 2026
  • CPCPLAB013 Allergen Testing, effective Jan. 1, 2026 
  • CPCPLAB014 Prenatal Screening (Nongenetic), effective Jan. 1, 2026 
  • CPCPLAB015 Hepatitis Testing, effective Jan. 1, 2026 
  • CPCPLAB016 Pediatric Preventive Screening, effective Jan. 1, 2026
  • CPCPLAB017 Celiac Disease Testing, effective Jan. 1, 2026 
  • CPCPLAB018 Helicobacter pylori Testing, effective Jan. 1, 2026
  • CPCPLAB019 Thyroid Disease Testing, effective Jan. 1, 2026
  • CPCPLAB020 Cardiovascular Disease Risk Assessment, effective Jan. 1, 2026
  • CPCPLAB023 Diagnosis of Idiopathic Environmental Intolerance, effective Jan. 1, 2026
  • CPCPLAB024 Epithelial Cell Cytology in Breast Cancer Risk Assessment, effective Jan. 1, 2026
  • CPCPLAB025 Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing, effective Jan. 1, 2026 
  • CPCPLAB026 Fecal Calprotectin Testing in Adults, effective Jan. 1, 2026
  • CPCPLAB027 Testing for Diagnosis of Active or Latent Tuberculosis, effective Jan. 1, 2026
  • CPCPLAB028 Immune Cell Function Assay, effective Jan. 1, 2026
  • CPCPLAB029 Intracellular Micronutrient Analysis, effective Jan. 1, 2026 
  • CPCPLAB030 In Vitro Chemoresistance and Chemosensitivity Assays, effective Jan. 1, 2026
  • CPCPLAB032 Oral Cancer Screening and Testing, effective Jan. 1, 2026
  • CPCPLAB033 Diagnostic Testing of Influenza, effective Jan. 1, 2026
  • CPCPLAB034 Salivary Hormone Testing, effective Jan. 1, 2026
  • CPCPLAB035 Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease, effective Jan. 1, 2026
  • CPCPLAB036 Serum Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases, effective Jan. 1, 2026
  • CPCPLAB037 Serum Tumor Markers for Malignancies, effective Jan. 1, 2026   
  • CPCPLAB038 Urinary Tumor Markers for Bladder Cancer, effective Jan. 1, 2026
  • CPCPLAB043 Evaluation of Dry Eyes, effective Jan. 1, 2026
  • CPCPLAB044 Lyme Disease Testing, effective Jan. 1, 2026
  • CPCPLAB045 Pathogen Panel Testing, effective Jan. 1, 2026
  • CPCPLAB046 Biomarkers for Myocardial Infarction and Chronic Heart Failure, effective Jan. 1, 2026
  • CPCPLAB047 Pancreatic Enzyme Testing for Acute Pancreatitis, effective Jan. 1, 2026
  • CPCPLAB048 Folate Testing, effective Jan. 1, 2026
  • CPCPLAB049 General Inflammation Testing, effective Jan. 1, 2026
  • CPCPLAB050 Urine Culture Testing for Bacteria, effective Jan. 1, 2026
  • CPCPLAB052 Testing for Vector-Borne Infections, effective Jan. 1, 2026
  • CPCPLAB053 β - Hemolytic Streptococcus Testing, effective Jan. 1, 2026
  • CPCPLAB055 Parathyroid Hormone, Phosphorous, Calcium and Magnesium Testing, effective Jan. 1, 2026
  • CPCPLAB056 Gamma-glutamyl Transferase in Adults, effective Jan. 1, 2026
  • CPCPLAB057 Coronavirus Testing in the Outpatient Setting, effective Jan. 1, 2026
  • CPCPLAB058 Venous and Arterial Thrombosis Risk Testing, effective Jan. 1, 2026
  • CPCPLAB059 Diagnosis of Vaginitis, effective Jan. 1, 2026
  • CPCPLAB061 Testing for Alpha-1 Antitrypsin Deficiency, effective Jan. 1, 2026
  • CPCPLAB063 Identification of Microorganisms Using Nucleic Acid Probes, effective Jan. 1, 2026
  • CPCPLAB064 Nerve Fiber Density Testing, effective Jan. 1, 2026
  • CPCPLAB065 Human Immunodeficiency Virus (HIV), effective Jan. 1, 2026
  • CPCPLAB067 Testing of Homocysteine Metabolism-Related Conditions, effective Jan. 1, 2026
  • CPCPLAB068 Onychomycosis Testing, effective Jan. 1, 2026
  • CPCPLAB069 Immunohistochemistry, effective Jan. 1, 2026
  • CPCPLAB070 Prescription Medication and Illicit Drug Testing, effective Jan. 1, 2026
  • CPCPLAB071 Colorectal Cancer Screening, effective Jan. 1, 2026

View policies on our CPCP page.

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.