Payer policy bulletins arrive every month and most of them go unread until a denial shows up with a reason nobody recognizes. February is a good month to catch up, because several changes announced in the January bulletins took effect on February 1, and at least one more lands on April 1. Below is what we found in the UnitedHealthcare commercial bulletin, where Cigna's modifier 25 policy actually stands, how the 2025 telemedicine codes are splitting the payer list, and the monthly routine we use so that none of this arrives as a surprise on a remittance.
A word on why this matters more than it used to. Payers now publish most changes 60 to 90 days ahead in a bulletin, which means a denial that lands in April for a change announced in January is a process failure in the billing office, not a payer trick. The payers know this, and appeals that say "we were not aware" go nowhere.
Key takeaways
- UnitedHealthcare commercial claims with two arthroscopic procedures on the same shoulder are bundled from February 1, 2025, and modifier 59 no longer bypasses the edit.
- UnitedHealthcare's new radiation therapy policy caps units of planning, simulation and management codes within a 90-day episode from February 1, 2025.
- HCPCS S9470 stops being payable by UnitedHealthcare commercial on April 1, 2025; bill medical nutrition therapy with 97802 and 97803.
- Cigna's modifier 25 documentation requirement was announced in 2023 and delayed after physician pushback; it has not been implemented, but the policy is still on Cigna's books.
- Every payer answers the 98000-series telemedicine question differently. Map the codes payer by payer.
UnitedHealthcare commercial: three items from the January 2025 bulletin
1. Shoulder arthroscopy code pairs, effective February 1, 2025
For dates of service on or after February 1, 2025, UnitedHealthcare is aligning its CCI Editing Policy (professional) and Outpatient Hospital CCI Editing Policy (facility) with the CMS National Correct Coding Initiative for shoulder arthroscopy codes 29805 to 29828. Code pairs describing two arthroscopic procedures on the same shoulder will not be considered for separate payment, and appending an NCCI modifier, including modifier 59, will not bypass the edit. Procedures on opposite shoulders remain separately payable with the appropriate modifier.
There are three exceptions, taken from Chapter IV of the NCCI manual: 29824 (distal claviculectomy), 29827 (rotator cuff repair) and 29828 (biceps tenodesis) may be paid in addition to 29823 (extensive debridement) when the debridement is in a different area of the same shoulder. Orthopedic practices should expect claim-line denials on the pairs they have been billing with modifier 59 and should review the operative note template so the "different area" language is explicit where it applies. This is the same rule Medicare has applied for years, so the surgeons' Medicare denials are a preview of what the UnitedHealthcare remittances will look like in March.
2. Radiation therapy unit limits, effective February 1, 2025
A new Radiation Therapy Dosimetry, Simulation/Devices and Management policy, professional and facility, sets unit limits during a 90-day episode of care that begins when a treatment planning code (77261, 77262 or 77263) is billed. A new episode starts if another planning code is billed before the 90 days end. The limits apply to the planning, simulation, dosimetry, device and management codes, not to the treatment delivery codes themselves. As one example from the policy, weekly treatment management code 77427 is limited to 9 units within the episode. Units above the limit for any listed code will not be paid. Radiation oncology billers should pull the full unit table from the policy document and load it as claim edits so overages are caught before submission rather than after.
3. HCPCS S9470 retired from payment, effective April 1, 2025
For dates of service on or after April 1, 2025, S9470 (nutritional counseling, dietitian visit) joins the UnitedHealthcare Commercial and Individual Exchange Replacement Codes policy. The code has a CMS status indicator of I (not valid for Medicare) and will not be paid. The bulletin points to CPT 97802 (initial medical nutrition therapy assessment and intervention, each 15 minutes) and 97803 (reassessment and intervention, each 15 minutes) as the replacement codes. Practices with registered dietitians should change their charge master before April 1, not after the first denial, and should check that the dietitians' visit templates record time, because the replacement codes are timed in 15-minute units and S9470 was not.
Cigna: where the modifier 25 policy actually stands
We still hear billers describe Cigna's modifier 25 rule as if it were in force. Here is the record. In early 2023 Cigna announced that claims with an established patient visit (99212 to 99215) carrying modifier 25 on the same day as a minor procedure would need the office note submitted with the claim, or the E/M line would be denied. The original effective date was May 25, 2023. After a letter from the AMA and more than 100 medical societies, Cigna delayed implementation and said it would revisit the requirement later with more provider education. As of February 2025 the documentation-with-claim requirement has not taken effect. Cigna's modifier 25 reimbursement policy remains published, and, like every payer, Cigna can request records after payment and recoup an E/M that does not show a significant, separately identifiable service.
Two things follow. Do not build a workflow that sends every Cigna office note up front; it costs staff time for no benefit today. Do build the note. A 99213-25 with a lesion destruction should read as two services: a problem addressed with its own history, exam or decision making, and a procedure. If Cigna or another payer revives a documentation-with-claim rule, the practice with good notes has a week of work; the practice without them has a revenue problem. We expect this policy to come back in some form, and the bulletins are where it will appear first.
The 2025 telemedicine codes: every payer has its own answer
CPT 2025 added codes 98000 to 98016 for telemedicine E/M. Medicare does not pay 98000 to 98015 and uses 98016 in place of G2012. Some commercial payers adopted the new codes from January 1, 2025 (several Blue plans said they would pay the audio-video codes 98000 to 98007, for example), some told practices to keep using 99202 to 99215 with modifier 95 or 93, and some have not said. Aetna, Cigna, Elevance's Anthem plans and the regional Blues each publish provider bulletins; check each one's telehealth policy before you decide how your scrubber maps a video visit. A single rule applied to every payer is guaranteed to be wrong for some of them, and the denial for the wrong choice is usually an "invalid procedure code" rejection that never reaches a work queue.
The monthly routine that prevents this from becoming denials
We think this is the part everyone skips, so here it is as a procedure with a name attached.
- Subscribe. Every payer that represents more than five percent of revenue has a provider news page or bulletin email. Someone in the billing office is subscribed to each one, under a shared mailbox, not a personal one, so the subscription survives staff turnover.
- Read on a date. The bulletins are read on the same day each month, and each item is sorted into three piles: applies to us, does not apply, unclear. "Unclear" gets a question to the payer representative the same week.
- Write the edit. Each "applies to us" item becomes a line in a payer rules sheet: payer, effective date, codes, what changes, source bulletin name and month, and the person who loaded the edit into the scrubber or charge master.
- Tell the people who need to know. A code retirement goes to whoever maintains the charge master. A documentation requirement goes to the providers. A unit limit goes to the coder. A telehealth mapping goes to the scrubber owner.
- Check the denials. Sixty days after the effective date, pull denials for that payer and confirm the new reason code (for the shoulder edit, expect a bundling reason such as CO-97 or CO-236) is not appearing. If it is, the edit did not land.
The whole routine takes a biller two to three hours a month for a practice with eight to ten meaningful payers. The denials it prevents take far longer to work, and some of them cannot be worked at all because the payer published the change on time.
This quarter's changes in one table
| Change | Payer | Effective | Who acts |
|---|---|---|---|
| Shoulder arthroscopy PTP edits, modifier 59 will not bypass | UnitedHealthcare commercial | February 1, 2025 | Orthopedic coder, surgeon note template |
| Radiation therapy unit limits per 90-day episode | UnitedHealthcare commercial | February 1, 2025 | Radiation oncology biller, scrubber edits |
| S9470 not payable; use 97802 / 97803 | UnitedHealthcare commercial | April 1, 2025 | Charge master owner, dietitian templates |
| Modifier 25 documentation with 99212 to 99215 | Cigna | Announced 2023, delayed, not in force | Providers (note quality), billing office (watch bulletins) |
| 98000 series telemedicine codes | Varies by payer | January 1, 2025 | Scrubber mapping by payer |
Questions we hear
We are not orthopedics or radiation oncology. Does the UnitedHealthcare bulletin matter to us?
The S9470 change matters to any practice with a dietitian, and the code update notice in the same bulletin is a reminder that UnitedHealthcare refreshes code lists in its policies whenever CPT, HCPCS or ICD-10 change, with the changes recorded in each policy's history section. The habit matters more than any single item. The month you skip the bulletin is the month your specialty is in it.
Our billing company handles this. Do we still need to read bulletins?
Ask the billing company for its payer rules sheet and the date it was last updated. If the answer is a blank look, you need to read them. If the sheet exists and has February 2025 entries, you can stop worrying about this part and spend the time on the provider-facing items, such as note templates, that the billing company cannot fix for you.
How do we find out about changes we missed?
The denial report will tell you, late and expensively. A denial management review that groups denials by payer and reason code usually surfaces two or three policy changes the practice never saw. Our billing service keeps the payer rules sheet as part of the monthly routine described above.
What to do this month
- Confirm someone is subscribed to the provider bulletins of every payer above five percent of revenue, under a shared mailbox.
- Orthopedic practices: review shoulder arthroscopy claims with modifier 59 for dates of service from February 1 and update the operative note template for the 29823 exceptions.
- Radiation oncology practices: load the unit limits from the UnitedHealthcare policy as pre-submission edits.
- Practices with dietitians: retire S9470 in the charge master for UnitedHealthcare commercial before April 1 and confirm visit templates capture time for 97802 and 97803.
- Pull ten Cigna claims with 99213-25 and a minor procedure and read the notes as a reviewer would.
- Write the payer-by-payer telemedicine code map and give it to whoever owns the scrubber.
- Start the payer rules sheet with this quarter's five entries.
