The following revisions have been made to our commercial claims editing software product to be consistent with HMSA's established reimbursement policies.
| Category of Service | CPT/HCPCS Codes | Processing action |
|---|---|---|
| Services that fall under the surgery code range but are considered diagnostic services | CPT codes: 59020 and 59025 | These codes continue to process as diagnostic services. Multiple surgery reduction and global surgery rules do not apply. |
| Sterilization performed following a vaginal delivery | Sterilization CPT codes: 58600, 58605, 58615, 58670, 58671. Vaginal delivery CPT codes: 59400, 59409, 59410, 59610, 59612, 59614 | Sterilizations following vaginal deliveries continue not to be subject to multiple surgery reduction rules when done in separate settings. |
| Procedures considered integral to the primary procedure | CPT codes: 34839, 92285, 93792, 93793, 98970, 98971, 98972, 99000, 99001, 99072, 99421, 99422, 99423, 99424, 99425, 99426, 99427, 99437, 99439, 99483, 99487, 99488, 99489, 99490, 99491, 99492, 99493, 99494, 0537T, 0538T, 0539T HCPCS codes: A9576, A9577, A9578, A9579, A9581, A9583, G0019, G0022, G0023, G0024, G0136, G0140, G0146, G0323, G0332, G0500, G0502, G0503, G0504, G0505, G0506, G0507, G2058, G2061, G2062, G2063, G2064, G2065, Q0091, Q9953 and Q9954, S0220, S3600, S3601 Effective March 1, 2023: G0179, G0180, G0181, G0182 Effective January 1, 2021: 99473, 99474, U0005* Effective March 1, 2020: G0463 Effective June 3, 2019: 0399T Effective May 1, 2015: 61781, 61782, 61783 Please note: Effective February 1, 2011, the following codes will be classified as integral to the primary procedure: 20930, 20936, 22841, 38204, 90885, 90887, 91123, 92352, 92353, 92354, 92355, 92358, 92371, 92531, 92532, 92533, 92534, 92605, 92606, 93740, 93770, 94005, 94150, 96902, 97010, 97602, 98960, 98961, 98962, 99002, 99024, 99051, 99058, 99070, 99071, 99078, 99090, 99091, 99288, 99339, 99340, 99363, 99364, 99366, 99367, 99368, 99374, 99377, 99379, 99380, A4262, A4270, A4300, A4550, G0269, Q3031, R0076 Effective June 08, 2021: M0201 | These codes continue to deny as integral to the associated primary procedure. In certain scenarios integral codes may deny as part of the case rate until the rule order can be reviewed and updated. *U0005 to deny as integral from 1/1/2021 to 2/28/2021. Effective 3/1/2021, U0005 will be separately payable. |
| Multiple endoscopy families | A list of CPT codes are available in the Multiple Endoscopy Procedures document. | Codes listed in the Multiple Endoscopy Procedures document continue to process according to the multiple endoscopy reduction rules. |
| Anesthesia qualifying circumstances modifier for age | CPT code 99100 | This edit was customized to process according to CPT code guidelines. |
| Miscellaneous medical and surgical supplies | HCPCS code A4649 | These codes are still considered incidental supplies when used during a physician office visit and are considered part of the established fees for E/M visits. See Supplies for additional information. |
| Cast supplies | HCPCS codes: A4580, A4590 | Cast supplies (A4580) continue to be processed for reimbursement when billed with special casting material (A4590). |
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform |