New and Updated Reimbursement Policies

New Reimbursement Policy 

Obstetrical/Maternity Care Services – Professional Reimbursement Policy

In our continued efforts to provide transparency regarding our reimbursement practices, EmblemHealth has established a formal policy to provide reimbursement guidance for maternity care services. The new policy also addresses key updates and code changes as announced by the American Medical Association (AMA) starting Jan. 1, 2027.

The following Reimbursement Policies have been updated. See revision history for updates and effective dates for the following policies:

• Coding Edits Policy (Commercial, Medicare, and Medicaid)
• Evaluation and Management (E&M) Services
• Modifier Reference Policy
• Preventive Medicine and Screening
• Prolonged Services
• Telehealth/Virtual Care Services