Payment Policy Updates

April 3, 2025

The following policies received their annual review with no changes:

• Consultation code Services
• Modifier 23
• Modifier 57
• Modifier 63
• Modifier 66
• Modifier 76
• Modifier 77
• Multiple Deliveries/Births
• Modifier TH
• Multiple Endoscopy Procedure Reductions

The following policies received their annual review with the changes noted below:

• Multiple Diagnostic Imaging Reductions
  • From the policy section: Revised the Multiple Procedures Rendered During the Same Session statement; removing the combined claims process and advising these services should be billed on the same claim
• Modifier CQ and CO
  • From the policy section removed “This 10 percent standard is also known as the "de minimis" standard as established by the Center for Medicare & Medicaid Services (CMS) CY 2022 final rule.” As the 10% rule was replaced by the standard “mid-point” rule for timed codes and added “the mid-point of the service (e.g., at least 8 minutes of a 15 minute service).”

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