Professional system updates for 2025

As a reminder, we will update our claim editing software for professional services throughout 2025, with most updates occurring quarterly. These updates apply to any provider, provider group (identified by tax identification number), and/or across providers and claim type (that is, professional or facility) and include, but are not limited to:

• The addition of new and revised codes (for example, CPT^®, HCPCS, ICD‑10, and modifiers) and associated edits such as:
• ICD‑10 laterality
• Add‑on procedures (indicated by + sign)
• Codebook parenthetical statements and other directives about appropriate code use (for example, separate procedure, do not report, and list separately in addition to)
• Updates to editing for multiple procedures and bilateral reduction calculations based on relative value unit (RVU) as designated and updated by the CMS in the physician fee schedule relative value (PFSRV) files
• Updates to National Correct Coding Initiative edits (NCCI) and medically unlikely edits (MUEs)
• Updates to incidental, mutually exclusive, and unbundled (re‑bundle) edits
• Updates to code edits associated with reimbursement policies including, but not limited to, bundled services, diagnostic radiopharmaceuticals, and contrast materials, global surgery preoperative and post‑operative periods assigned by CMS, edits that allow/disallow for an assistant surgeon/co‑surgeon/team surgeon, and frequency edits