December 2025

As the days grow shorter and the holiday season approaches, patients may be facing a heightened risk for mood disorders, particularly Seasonal Affective Disorder (SAD). Recognized as Seasonal Affective Disorder Awareness Month, December serves as a critical reminder for healthcare professionals to proactively screen, identify, and support patients who may be struggling with seasonal mood changes and holiday-related emotional stressors.

Understanding SAD and Holiday-Related Mood Risks
Seasonal Affective Disorder is a subtype of major depressive disorder characterized by a recurrent seasonal pattern, most commonly manifesting in the fall and winter months. Symptoms include persistent low mood, hypersomnia, carbohydrate cravings, weight gain, and social withdrawal. SAD affects approximately 0.4% to 10% of the population depending on latitude, with subsyndromal symptoms impacting up to 20%.

The holiday season can further exacerbate mood disorders due to financial strain, grief, loneliness, and disrupted routines. Studies show that 38% of Americans report increased stress during the holidays, with many experiencing symptoms consistent with depression or anxiety.

The Importance of Screening During the Holidays
Despite its prevalence, SAD often goes undiagnosed. In one study, 60% of individuals with SAD had never received treatment for depression. Primary care and specialty providers are well-positioned to identify early signs through routine screening. 

Recommended screening tools include:

• Seasonal Pattern Assessment Questionnaire (SPAQ): Assesses seasonal changes in mood, sleep, appetite, and energy.
• PHQ-9: Useful for general depression screening.
• Beck Depression Inventory – SAD Version (BDI-SAD): Tailored to vegetative symptoms like hypersomnia and carbohydrate cravings.

Patients Most at Risk
Older adults are at a higher risk for SAD and holiday depression due to factors like social isolation, chronic health conditions, and financial stress, compounded by the reduced daylight of winter and the emotional pressure of the holidays. Key risks include living alone, loss of a loved one, difficulty with mobility or transportation, and the inability to afford to participate in holiday traditions.

Other populations at higher risk include those with prior depressive episodes, chronic illness, caregivers, and individuals living in northern latitudes.

Counseling Strategies for SAD and Holiday Mood Disorders
Empathetic, evidence-based counseling can empower patients to manage seasonal mood changes. Key strategies include:

• Educate About SAD: Explain the biological basis—reduced sunlight disrupts circadian rhythms, serotonin, and melatonin levels.
• Promote Behavioral Activation: Recommend regular physical activity, social engagement, and outdoor exposure. Even brief daylight walks can improve mood.
• Discuss Medication Options: SSRIs such as sertraline and fluoxetine are effective for SAD. Monitor for side effects and seasonal adherence patterns. Remember that SSRIs can increase anxiety during the first few months. Start at half the usual starting dose in patients with comorbid anxiety.
• Address Holiday-Specific Stressors: Explore grief, financial strain, and social isolation. Normalize these experiences and offer coping strategies such as boundary-setting and realistic expectations.
• Support Self-Care and Routine: Help patients develop personalized self-care plans, including sleep hygiene, nutrition, and mindfulness practices.
• Connect to Resources: Refer to mental health professionals, support groups, and community services. Telehealth options can be especially valuable during winter months. 

A Call to Action
December is more than a time for celebration—it’s a time for vigilance. By integrating screening tools, offering compassionate counseling, and collaborating across disciplines, prescribers and physicians can significantly reduce the burden of SAD and holiday-related depression. Early recognition and intervention can transform a season of struggle into one of support and healing.

References

1. Michalak et al. Br J Psychiatry. 2001;179(1):31–34. Cambridge Core 
2. Avery D. UpToDate. 2024. UpToDate SAD Overview
3. NIMH. Seasonal Affective Disorder. NIMH SAD Fact Sheet
4. Field T. J Clin Psychol Neurol. 2024. Narrative Review
5. Cleveland Clinic. Holiday Depression. Health Essentials
6. Medscape. SAD Workup. Medscape Psychiatry
7. Vanderbilt University. Seasonal Self-Care. Vanderbilt News
8. ADAA. Holiday Stress and SAD Toolkit. ADA Toolkit PDF [ada.org]
9. Mission Connection. SAD Coping Strategies. Mission Connection Healthcare

The Clinical Practice Guidelines (CPGs) have been reviewed and approved by Independent Health's Quality Performance Committee and updated, where necessary. Changes include adoption of the following guideline:

Substance Use Disorder Treatment Statutes, Regulations, and Guidelines: SAMHSA

The following guidelines have had updated web links: 

• AAP Immunization Schedule: New link
• Adult Immunization Schedule by Age (Addendum updated Aug. 7, 2025). 
• Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: AHA, ACC, AANP, et.al)
• New High Blood Pressure Guideline emphasizes prevention, early treatment to reduce CVD risk: AHA/ACC
• American Association of Pain Management Clinical Guidelines

To view the updated clinical practice guidelines in the secure provider portal, go to Clinical Practice Guidelines under the Policies & Guidelines Menu Item.

Effective for New York State (NYS) Medicaid Fee-for-Service (FFS) and Medicaid Managed Care (MMC) plans, costs related to phosphate binders provided during a dialysis session should be bundled into the payment for the visit for dates of service on or after January 1, 2026.

Dialysis patients should not be referred to a pharmacy to obtain phosphate binders on or after January 1, 2026.

This change is to align with recent policy changes by the Centers for Medicare & Medicaid Services (CMS), and it reflects the increased costs incurred by End Stage Renal Disease (ESRD) facilities related to the acquisition and storage of oral phosphate binders.

Please note: For acute kidney injury (AKI) patients, binders remain covered under Medicare Part D. For NYS Medicaid members with AKI, binders remain covered under the NYS Medicaid pharmacy benefit (NYRx), not through the APG dialysis clinic payment. This policy ensures alignment between Medicare and NYS Medicaid coverage for AKI patients.

For Questions and Additional Information

Provider Relations is available to help Monday through Friday, between 8 a.m. and 5 p.m.  Call (716) 631-3282 or 1-800-736-5771.

FFS and NYRx claim questions should be directed to the eMedNY Call Center at (800) 343-9000.

FFS coverage and policy questions should be directed to the Office of Health Insurance Programs (OHIP) Division of Program Development and Management (DPDM) by telephone (518) 473-2160 or by email at FFSMedicaidPolicy@health.ny.gov.

MMC reimbursement, billing, and/or documentation requirement questions should be directed to the specific MMC Plan of the enrollee. MMC Plan contact information is available in the eMedNY New York State Medicaid Program Information for All Providers - Managed Care Information document.

To ensure compliance with standards established by New York State for our participating providers, Independent Health partnered with an outside vendor, PressGaney, to conduct brief surveys by phone regarding appointment access and availability for our members.  This survey was directed to specific types of providers, including primary care physicians, medical oncologists, OB/Gyns, psychiatrists, and psychologists.

The primary objectives of this survey are:

• To comply with state regulations set forth in Independent Health’s contract with the state of New York.
• To provide quantifiable feedback to Independent Health regarding physician compliance with the access and availability.
• To help Independent Health improve the services provided to its members.

All scenarios presented are based on the following types of care:

• Emergent
• Urgent
• Sick visits (routine non-urgent/emergent)
• Initial and Follow-up Routine, non-urgent or preventative care
• Adult baseline and routine physicals
• Non-life-threatening emergency care
• Prenatal Trimester Care
• Hospital Discharge Follow-up treatment

2025 Summary of Results:

The Appointment Availability and After-Hours Surveys were administered between July 2 and July 18, 2025. The overall compliance rates were:

• 54% among all providers for the Appointment Availability
• 88% for After-Hours  

Any office that was found out of compliance will be notified by Independent Health and sent an action plan that requires a plan of correction. We would like to thank all the providers who participated in the survey.

Please take note, we have renamed and updated the Inquiry and Administrative Sanctions Appeal Policy, effective January 1, 2026.  The new policy is called the Provider Post-service Payment Dispute and Administrative Sanctions Appeal policy, which includes the following:

• We are requesting that all post- service payment disputes about claim denials or reimbursement be submitted using a completed Provider Payment Dispute Form, along with appropriate supporting documentation.
• The Provider Payment Dispute Form replaces the Provider Inquiry Form. 
• Independent Health will review the post service payment dispute within 30 days of receipt.  If the denial is upheld, we will send a response in writing. 
• Uphold decisions are considered final.  There will no longer be an option to request a reconsideration appeal after receiving an uphold decision.

CMS has published significant changes to the CPT code list for Radiation Oncology. Evolent will be adopting these changes for Pre-Authorization effective 1/1/2026.

Starting 1/1/2026, the same set of CPT codes will be used across all Places of Service.

The following codes will be deleted / retired effective January 1, 2026:

CPT / HCPCS DESCRIPTION

• G6001  IGRT - Ultrasound
• G6002  IGRT - Stereoscopic kv/kv
• G6003  Radiation Treatment Delivery – Simple <5MV
• G6004  Radiation Treatment Delivery – Simple 6-10MV
• G6005  Radiation Treatment Delivery – Simple 11-19MV
• G6006  Radiation Treatment Delivery – Simple >20MV
• G6007  Radiation Treatment Delivery – Intermediate <5MV
• G6008  Radiation Treatment Delivery – Intermediate 6-10MV
• G6009  Radiation Treatment Delivery – Intermediate 11-19MV
• G6010  Radiation Treatment Delivery – Intermediate >20MV
• G6011  Radiation Treatment Delivery – Complex <5MV
• G6012  Radiation Treatment Delivery – Complex 6-10MV
• G6013  Radiation Treatment Delivery – Complex 11-19MV
• G6014  Radiation Treatment Delivery – Complex >20MV
• G6015  Radiation Treatment Delivery - IMRT
• G6016  Radiation Treatment Delivery – IMRT Compensator-Based
• G6017  IGRT – Intrafraction Localization and Tracking
• 77014   IGRT – Conebeam CT
• 77385   Radiation Treatment Delivery - Simple
• 77386   Radiation Treatment Delivery - Complex
• 77401   Radiation Treatment Delivery - Superficial
• 0394T   Radiation Treatment Delivery - Electronic Brachytherapy - Skin

The following new codes will be added effective January 1, 2026:

CPT / HCPCS DESCRIPTION

• 77436   Surface radiation therapy; superficial or orthovoltage, treatment planning and simulation-aided field setting, once per course of treatment
• 77437   Superficial treatment delivery; includes electronic brachytherapy; <150 kV, per fraction
• 77438   Orthovoltage treatment delivery, >150-500 kV, per fraction
• 77439   Superficial or orthovoltage, image guidance, ultrasound for placement of radiation therapy fields for treatment of cutaneous tumors, per treatment fraction

With the addition of 77436 and 77439 for superficial and Orthovoltage treatment, the use of CPT 77280-77290 or G6002 will no longer be supported for skin superficial, orthovoltage or electronic brachytherapy services effective 1/1/2026.

For Health Plans that have Electronic Brachytherapy – Skin CPT 0394T in scope, this service will now be represented by the new CPT code 77437.

With the deletion of IMRT codes CPT 77385, 77386, G6015, G6016 – all IMRT will now be reported with CPT 77407 or 77412. New code descriptions for CPT 77402, 77407, 77412 will be effective on 1/1/2026. The new code descriptions are significantly different from the descriptions used for these codes in the past. Providers are encouraged to pay special attention to these changes and make the necessary changes in your EMR, billing and claims systems.

All IGRT codes, except for CPT 77387 will be deleted / retired. Effective 1/1/2026, ALL forms of IGRT, including intrafraction tracking will be represented by 77387 for all Places of Service. The professional component of 77387 can be reported for 3D and IMRT. The technical component is factored into the reimbursement of the treatment codes and is no longer reported separately.

CPT / DESCRIPTION

• 77402   Radiation treatment delivery, Level 1 (e.g., single electron field, multiple electron fields, or 2D photons)
• 77407   Radiation treatment delivery, level 2, single isocenter (e.g., 3D or IMRT), photons, including imaging guidance, when performed
• 77412   Radiation treatment delivery, level 3 multiple isocenters with photon therapy (e.g., 2D, 3D, or IMRT) OR a single isocenter photon therapy (e.g., 3D or IMRT) with active motion management, OR total skin electrons, OR mixed electron/photon field(s), including imaging guidance, when performed
• 77387   Guidance for localization of target volume for delivery of radiation treatment, all forms of IGRT, includes intrafraction tracking, when performed – professional component only; (technical component factored into all treatment code and no longer reported for any place of service).

Flu Shot Campaign

This campaign will encourage adult members to receive a flu vaccine this season.  Practices are also encouraged to further reinforce the importance of the flu vaccine with their patients.

• Target Population: Adult members in Commercial, State Programs, and Medicare lines of business
• Outreach method: Email and digital correspondence
• Timeframe: September 2025 to January 2026

State Member Incentive Program Campaigns

Independent Health State members will have until December 31, 2025, to complete various preventive care visits and screenings to receive an incentive for the following programs:

• Gaps-in-Care Program - State members can earn gift cards for completing various preventive care tests and screenings included in the program.
• Non-Utilizer Program - State members with 7 or more months of continuous enrollment without a claim on file are eligible to earn a gift card for completing an annual well visit.
• Maternity Management Program - State members can earn gift cards for completing a prenatal visit during the first 12 weeks of pregnancy and postpartum visit within 11 weeks after delivery.
• Timeframe: July through December 31, 2025

Health-Related Social Needs Self Screening

This campaign will encourage Essential Plan members to complete a health-related social needs screening, and we will provide referral information for community resources if an area of need is identified.

• Target Population: Essential Plan members
• Outreach Method: Email and telephone
• Timeframe: July to December 2025

Osteoporosis Management in Women Who Had a Fracture (OMW) Member Outreach

Independent Health’s Member Success Team will outreach telephonically to Medicare members who fall into the Osteoporosis Management in Women Who Had a Fracture (OMW) measure. The Member Success Team will contact members to provide education on the importance of getting screened for osteoporosis following a fracture and discuss options for gap closure. The option of an in-home heel ultrasound with Stall Senior Medical (SSM) will be discussed. If the member is interested, The Member Success Team will ask for consent for the member to be contacted by the SSM team and then SSM will call the member to schedule the appointment. All results will be sent to the member’s Primary Care Physician (PCP) for follow-up. The Member Success Team will also discuss other options for gap closure, depending on the member’s preference, and refer back to the member’s PCP. Each call will be individualized based on the member’s needs.

• Target population: The OMW measure focuses on females 67 to 85 years of age who had a fracture and have six months following the fracture to close the gap by having a bone density scan, filling a prescription for an osteoporosis medication, or receiving an injection for osteoporosis treatment.
• Timeframe: This outreach is on-going. Monthly, new members who fall into this measure are called. 

Drug Formulary Changes

• View the formulary changes for the Fourth Quarter of 2025.
• Access Independent Health's drug formularies here.

Drug Policy Changes

The policy changes for the Fourth Quarter of 2025 are now available online. Log in to the provider portal to view the changes. Click on ‘Monthly Policy Updates’ under the News tab once you are logged in.

Search for and view the most current versions of all Independent Health’s drug policies when logged in to our provider portal.

Prime Therapeutics reviews prior authorizations for select oncology and specialty drugs on Independent Health's behalf. Log in to view Prime Therapeutics policies for the drugs it reviews. 

To obtain a hard copy, please contact Independent Health Provider Relations by calling (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 5 p.m.

Independent Health to join MVP Health Care Family of Companies - Nov. 18, 2025

MVP Health Care and Independent Health are proud to announce that Independent Health will join MVP’s family of companies, subject to regulatory approvals. All our stakeholders, including members, providers, employers, and partners, can expect business as usual with no immediate changes to coverage, benefits, provider reimbursement or local personalized service.