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TO: Physicians,
Certified Registered Nurse Practitioners (CRNPs), Physician Assistants (PAs),
and EPSDT Screening Providers
RE: Additional
Diagnoses Information via CPT 99499
Effective January 1, 2026, physicians, nurse practitioners, physician assistants, and EPSDT screening providers can submit up to 24 additional diagnosis codes per date of service by submitting up to two claims for CPT 99499 (unlisted/unspecified) per date of service as a claim detail.
Claims for this code should not include other procedure codes.
Medicaid will pay $0.00 on claims for CPT 99499.
Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) should bill CPT 99499 as a fee-for-service claim. Prospective payment rates will not be reimbursed for claims for this code.
This information will be updated in the following sections of the January 2026 Provider Billing Manual:
Section 21.5.2 of Chapter 21 – Certified Registered Nurse Practitioners and Physician Assistants and
Section 28.6.2 of Chapter 28 – Physicians.
For billing inquiries, please contact the Provider Assistance Center at 1-800-688-7989.
The Current Procedural Terminology (CPT) and Current
Dental Terminology (CDT) codes descriptors, and other data are copyright © 2025 American Medical Association
and © 2025 American Dental Association (or such other date publication of CPT and
CDT). All rights reserved. Applicable FARS/DFARS apply.