May 27, 2026
Reimbursement policies, formerly known as 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 reimbursement policy positions as part of our ongoing policy review process.
The following policies were updated:
- RP004 Neonatal Intensive Care Unit Level of Care Authorization and Reimbursement Policy, effective May 22, 2026
- RP038 Outpatient Services Prior to an Inpatient Admission, effective May 22, 2026
- RP044 Global Obstetrical/OB Maternity Services Policy, effective May 22, 2026
CPT copyright 2025 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.