Reimbursement Policy Updates

Aug. 25, 2026 

Reimbursement policies, formerly known as 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:

  • Chiropractic Care Services, effective July 24, 2026
  • Clinical Laboratory Reimbursement Policy, effective Aug. 18, 2026
  • Modifier Reimbursement and Reference Policy, effective Oct. 19, 2026
  • Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) Reimbursement Policy- Non-Reimbursable EIU Services/ Codes, effective Aug. 15, 2026
  • RBRVS and Anesthesia Conversion Factor Reimbursement Policy, effective Aug. 1, 2026
  • Robotic Assisted Surgery, effective Aug. 4, 2026
  • Trauma Activation - Facility Services, effective Aug. 14, 2026 
  • RPLAB004 Diabetes Mellitus Testing, effective Dec. 4, 2026
  • RPLAB014 Prenatal Screening (Nongenetic), effective Dec. 4, 2026
  • RPLAB032 Oral Cancer Screening and Testing, effective Dec. 4, 2026
  • RPLAB045 Pathogen Panel Testing, effective Dec. 4, 2026 
  • RPLAB046 Biomarkers for Myocardial Infarction and Chronic Heart Failure, effective Dec. 4, 2026
  • RPLAB049 General Inflammation Testing, effective Dec. 4, 2026
  • RPLAB050 Urine Culture Testing for Bacteria, effective Dec. 4, 2026
  • RPLAB056 Gamma-glutamyl Transferase Testing in Adults, effective Dec. 4, 2026
  • RPLAB057 Coronavirus Testing in the Outpatient Setting, effective Dec. 4, 2026
  • RPLAB061 Testing for Alpha-1 Antitrypsin Deficiency, effective Dec. 4, 2026
  • RPLAB063 Identification of Microorganisms Using Nucleic Acid Probes, effective Dec. 4, 2026
  • RPLAB071 Colorectal Cancer Screening, effective Dec. 4, 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 2025 American Medical Association. All rights reserved. CPT is a registered trademark of the AMA. 

Reimbursement Policies (formerly known as Coding and Compensation Policies) are based on health care professionals’ and industry standard guidelines. The reimbursement 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