CPT 88305

Policy Update #: POLCPT053126
Effective Date: May 31, 2026 (Professional); June 30, 2026 (Facility)
Current State: CPT code 88305 is currently a part of the procedure to diagnosis coding compatibility edits. This edit fires based on CPT code 88305 being billed with an incompatible ICD-10 diagnosis code.
Future State: New Policy - CPT code 88305 will now be considered as a part of the Daily Maximum Frequency editing for Sentara Health Plans. Sentara Health Plans will limit reimbursement of CPT 88305 based on a maximum number of units per member, per provider, per date of service. Services billed in excess of the established daily maximum units will be denied as not medically necessary or not separately reimbursable.
Applicable Plan(s): Commercial, Medicaid and Medicare
Applicable Policy: N/A
Policy Number: TBD
Business Owner: Payment Policy

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CPT 88305 Policy Update