Here are the latest updates to our payment policies. You’ll need to log in to see the policy updates.
April 1, 2021
Summary of policy updates:
Evaluation and Management Visits Billed with Preventive Medicine Exam
Clarified the purpose statement to
indicate that the policy pertains to professional services billed on a CMS-1500 paper or 837P electronic claim form. Added termination date on code 99201. Updated new and established office visit codes with their revised code descriptions effective
January 1, 2021.
Hospital or Hospital System Readmissions
Clarified in the purpose statement that the policy applies to facility services billed on a UB-04/CMS-1450
paper claim form or 837I electronic claim form.
Modifier 25-Significant, Separately Identifiable E&M Service
Clarified the purpose statement to indicate that the policy
pertains to professional services billed on a CMS-1500 or 837P electronic claim form.
Modifier 58 – Staged or Related Procedure or Service During Postoperative Period
Clarified the
purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form. Added code examples for procedure codes with “one or more sessions” in their code descriptions. Clarified when the
use of modifiers 78 and 79 are more appropriate.
Modifier 91 – Repeat Clinical Diagnostic Laboratory Test
Clarified the purpose statement to indicate that the policy pertains
to professional services billed on a CMS-1500 or 837P electronic claim form. Added code examples to the “multiple tests” referenced in the last paragraph of the policy statement.
Physical and Occupational Therapy Services
Clarified the purpose statement to indicate that the policy pertains to professional services
billed on a CMS-1500 or 837P electronic claim form. Identified unit limits for the timed codes noted in the policy section.
Robotic Surgical System and Computer Assisted Navigation Codes
Clarified the purpose statement to indicate that the
policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form and to facility services billed on a UB-04/CMS-1450 paper claim form or 837I electronic claim form.
Screening Services with E&M Service
Clarified the purpose statement to indicate that the policy pertains to professional services billed on
a CMS-1500 or 837P electronic claim form.
Site Specifying Modifiers
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic
claim forms. The eyelid, finger, and toe individual modifiers are listed. Added last paragraph in the policy section to indicate reimbursement modifiers should be billed in the primary position and all other modifiers subsequently.
(NEW) Teledentistry
Dental services that are approved to be delivered via audio and video telecommunications system include the following dental services:
- D0140 – Limited oral evaluation-problem focused
- D0170 – Re-evaluation-limited, problem focused (established patient, not post-operative visit); assessing the status of a previous condition
- D0171 – Re-evaluation-post-operative office visit
- D0190 – Screening of patient to determine if individual needs to be seen in person by a dentist
These services must be billed with the following codes to identify the services provided via teledentistry:
- D9995 – Teledentistry-synchronous; real-time encounter
- D9996 – Teledentistry-asynchronous; information stored and forwarded to dentist for subsequent review.
Additional details on how to document a teledentistry encounter can be found in the policy.