Additional Diagnoses Information via CPT 99499

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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 © 20 25 American Medical Association
and © 20 25 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.