Payment Policy Updates

March 6, 2025

The following policies received their annual review with no changes:

• Drugs Administered in a Physician Office
• Manipulation Services
• Modifier 24- Unrelated Evaluation & Management Service by the Same Physician in the Post-Operative Period
• Modifier 47-Anesthesia by Surgeon
• Modifier 50-Bilateral Procedure
• Abortions-Professional Services
• Modifier GA-Waiver of Liability

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

Abortions-Facility Services

Added condition code “AC” to the end of the policy section.

Manipulation Services

Added Physical Medicine and Rehabilitation Services to the cross-reference section.

Maternity Services

In the policy section:

• Revised the global obstetrics package details for uncomplicated outpatient postpartum visits up to 6 weeks" to "6- 8 weeks.
• Under Postpartum care services changed from eight weeks to 6-8 weeks.

Multiple surgical reductions

In the policy section:

• Removed statement “or 50% of the per procedure billed charge, whichever is less, per provider contract” from the surgical procedure details in the policy statement.
• Added statement “Modifiers XE, XS, XP, XU– Separate Encounter, Separate Structure, Separate Practitioner, and Unusual Overlapping Service and Modifier 59– Distinct Procedural Services do not prevent multiple surgical reductions from being applied.” to the end of the policy section.

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