CurrentEmblemHealthPolicy N/A

CPT/HCPCS New Code Update Process

This policy governs how EmblemHealth and ConnectiCare process claims that include newly released CPT/HCPCS codes and how such claims are adjudicated and reprocessed; it affects claims processing staff and providers submitting claims to EmblemHealth/ConnectiCare.

Policy Summary

PayerEmblemHealth

PolicyCPT/HCPCS New Code Update Process

Policy CodePolicy N/A

Change TypeOperational (process change)

Effective DateJul 1, 2024

Next Review DateN/A

Key ActionClaims with new CPT/HCPCS codes will be adjudicated normally while the new code lines are appended with CO-133 and reprocessed after codes are configured.

SourceLink

POLICY UPDATE CHANGES

A new code load process will adjudicate claims normally for services except for new codes, which will be appended with CO-133 and reprocessed after configuration.

60 daystarget to load and configure each code update

Quarterlyfrequency of AMA/CMS code set updates

Jul 2024effective date for new code load process

New Code Claims Handling

New code claims handling

Covered handling and downstream effects for claims containing newly released CPT/HCPCS codes:

Claims containing newly released CPT and/or HCPCS codes will be adjudicated normally for all other services on the claim; new code line(s) will not cause the entire claim to be held.

New CPT and/or HCPCS code line(s) will be appended with Claim Adjustment Reason Code CO-133 indicating 'The disposition of this service is pending further review.'

Once the new CPT and/or HCPCS codes have been configured/loaded into the claims processing system, affected claims will be reprocessed to ensure proper adjudication of the entire claim.

Reprocessing of claims containing new codes does not guarantee payment; the newly configured codes may trigger reimbursement policy edits upon re-adjudication (including recoveries or multiple procedure reductions).

Policy Summary

PayerEmblemHealth

PolicyCPT/HCPCS New Code Update Process

Policy CodePolicy N/A

Change TypeOperational (process change)

Effective DateJul 1, 2024

Next Review DateN/A

Key ActionClaims with new CPT/HCPCS codes will be adjudicated normally while the new code lines are appended with CO-133 and reprocessed after codes are configured.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Adjudication and Claim Adjustment Handling

Billing Rule

New code adjudication and CO-133 handling — provider action

Effective July 2024, newly loaded CPT and/or HCPCS codes will be adjudicated like other services, except that any new code(s) requiring configuration will be appended with an electronic Claim Adjustment Reason Code (CO-133) indicating: "The disposition of this service is pending further review." Once the new CPT and/or HCPCS codes have been fully loaded into our claims processing system, affected claims will be reprocessed to ensure proper adjudication. Providers should be aware this process does not guarantee payment for the new code(s) (or for previously adjudicated services on the same claim); the addition of new codes may trigger reimbursement policy edits (for example, multiple procedure reductions) which can result in recoveries or adjustments to amounts previously paid.

New CPT and/or HCPCS codes appended with CO-133: "The disposition of this service is pending further review."
Claims with affected new code(s) will be reprocessed after codes are configured in the claims system.
Reprocessing may result in payment changes or recoveries if reimbursement policy edits (e.g., multiple procedure reductions) apply.
CO-133 is informational and indicates pending review — it does not guarantee payment.

Terminology

Claim Adjustment Reason Code CO-133

Reason code and meaningCO-133 — 'The disposition of this service is pending further review'.

When usedAppended to new CPT/HCPCS code lines that require configuration when claims are adjudicated under the July 2024 process.

Effect on adjudicationClaims are adjudicated normally for other services; new code lines receive CO-133 and the claim is not held pending configuration.

Follow-up actionOnce the new codes are loaded into the claims processing system, claims with CO-133 will be reprocessed to ensure proper adjudication.

Payment guaranteeThis handling does not guarantee payment; reprocessing may trigger reimbursement policy edits or recoveries (e.g., multiple procedure reductions).

OpenPayer

CPT/HCPCS New Code Update Process

New Code Claims Handling

New CPT/HCPCS Codes and Configuration Targets

Adjudication and Claim Adjustment Handling

Terminology