Oct. 29, 2025
Coding and Compensation Policies describe payment rules and methodologies for Current Procedural Terminology (CPT®) codes, Healthcare Common Procedure Coding System and ICD-10-CM 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 coding and compensation policy positions as part of our ongoing policy review process.
The following policies were updated:
- Durable Medical Equipment, Oxygen, Prosthetic/Orthotic and Supplies Compensation Policy, effective Oct. 1, 2025
- Emergency Department Services Evaluation and Management – EM Coding – Facility Services, effective Oct. 6, 2025
- Fee Schedule Clerical Error Policy, effective Sept. 26, 2025
- HMK Therapeutic Group Home Compensation Policy, effective July 1, 2025
- Hospital Compensation Policy, effective Sept. 26, 2025
- Hospital Compensation Policy Revenue Codes Requiring CPT-HCPCS Codes, effective Sept. 26, 2025
- Non-Reimbursable Experimental, Investigational and/or Unproven Services Policy, effective Jan. 1, 2026
- Non-Reimbursable EIU Services Code List, effective Jan. 1, 2026
- Observation Services Policy, effective Dec. 15, 2025
- Place of Service Compensation Policy, effective Sept. 26, 2025
- Preventable Adverse Events Policy, effective Sept. 26, 2025
- Preventive Services Policy, effective Sept. 26, 2025
- Psychiatry/Psychotherapy Services – Professional Provider, effective Dec. 15, 2025
- RBRVS Compensation Policy, effective Sept. 30, 2025
- Sleep Diagnostic Services Policy, effective Sept. 30, 2025
- Sports Physical Compensation Policy, effective Sept. 30, 2025
- Website Publication Policy, effective Sept. 30, 2025
- CPCPLAB002 Cervical Cancer Screening, effective Jan. 3, 2026
- CPCPLAB004 Diabetes Mellitus Testing, effective Jan. 3, 2026
- CPCPLAB005 Prostate Biopsy Specimen Analysis, effective Jan. 3, 2026
- CPCPLAB014 Prenatal Screening (Nongenetic), effective Jan. 3, 2026
- CPCPLAB017 Celiac Disease Testing, effective Jan. 3, 2026
- CPCPLAB024 Epithelial Cell Cytology in Breast Cancer Risk Assessment, effective Jan. 3, 2026
- CPCPLAB025 Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing, effective Jan. 3, 2026
- CPCPLAB027 Testing for Diagnosis of Active or Latent Tuberculosis, effective Jan. 3, 2026
- CPCPLAB030 In Vitro Chemoresistance and Chemosensitivity Assays, effective Jan. 3, 2026
- CPCPLAB032 Oral Cancer Screening and Testing, effective Jan. 3, 2026
- CPCPLAB033 Diagnostic Testing of Influenza, effective Jan. 3, 2026
- CPCPLAB035 Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease, effective Jan. 3, 2026
- CPCPLAB036 Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases, effective Jan. 3, 2026
- CPCPLAB045 Pathogen Panel Testing, effective Jan. 3, 2026
- CPCPLAB050 Urine Culture Testing for Bacteria, effective Jan. 3, 2026
- CPCPLAB051 Diagnostic Testing of Common Sexually Transmitted Infections, effective Jan. 3, 2026
- CPCPLAB052 Testing for Vector-Borne Infections, effective Jan. 3, 2026
- CPCPLAB053 β - Hemolytic Streptococcus Testing, effective Jan. 3, 2026
- CPCPLAB056 Gamma-glutamyl Transferase Testing in Adults, effective Jan. 3, 2026
- CPCPLAB059 Diagnosis of Vaginitis, effective Jan. 3, 2026
- CPCPLAB061 Testing for Alpha-1 Antitrypsin Deficiency, effective Jan. 3, 2026
- CPCPLAB065 Human Immunodeficiency Virus, effective Jan. 3, 2026
For more details, refer to the revised policies in Availity® Essentials through the Plan Documents Viewer application. You can access the application in Payer Spaces for Blue Cross and Blue Shield of Montana.
CPT copyright 2024 American Medical Association. All rights reserved. CPT is a registered trademark of the AMA.
Coding and Compensation Policies are based on health care professionals’ and industry standard guidelines. The coding and compensation guidelines are not intended to provide billing or coding advice but to serve as a reference for facilities and providers.
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.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSMT. BCBSMT makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.