April 4, 2024
The following policies received their annual update with no changes:
The following policies received their annual update with the changes noted below:
COVID-19 Testing: Diagnostic, Surveillance and Over the Counter
In the Codes/Coding Guideline section, added code termination dates to codes U0003, U0004 and U0005.
Drug Assay Services/Urine Drug Testing
Policy title changed from “Drug Assay Services/Urine Drug Testing” to “Urine Drug Testing/Drug Assay Services.”
Drugs Administered in a Physician Office
In the Policy section, revised the third paragraph to include additional resources and a notation for References and Resources section of the policy. In the References and Resources section of the policy, additional resources were added.
Durable Medical Equipment (DME) / Home Medical Equipment (HME)
Effective with claim process dates on and after July 5, 2024, the following changes/updates will become effective:
- In the Definitions section, expanded the definitions for Durable Medical Equipment and Rental to Purchase or Purchased Equipment.
- In the “Rental-Only-Services” section, added clarification on how to code/bill for partial month rentals and added the last paragraph.
- Added “new” section “Oxygen Rentals Only.”
- In the “Replacement of DME, Orthotic or Prosthetic item” section:
- Added sub-bullet examples to the first paragraph.
- Added an explanation in the second and third paragraphs which modifier combinations should be appended for rental replacement and purchase replacement respectively.
- In the “Modifiers” section:
- Removed modifier LL.
- Clarified how to bill modifier RA.
- Added eyelid, toe and finger modifiers.
- Removed modifier 59 and X-series modifiers.
- Added “new” section “Functional Modifiers.”
- In the “Related Services” section, added examples of “member’s home” to the third paragraph.
- Updated the code list in the embedded link as follows:
- New codes added effective with dates of service on and after 01/01/2024: E0530, E0678, E0679, E0680, E0681, E0682, E0732, E0733, E0734, E0735, E1905, E2001, E2398 and E3000.
- Terminated codes effective with dates of service on and after 01/01/2024: K1001 through K1033.
- In the Codes/Coding Guidelines section, added new coding guidelines and removed the list of “Unlisted Codes.”
Modifier 24 – Unrelated Evaluation & Management Service by the same Physician in the Post-Operative Period
Corrected how the same physician or other qualified healthcare provider is determined based on the provider’s Taxonomy and Tax ID number rather than on provider NPI number.
Modifier 50 - Bilateral Procedure
Added the third paragraph which discusses laterality and the correct use of modifiers LT, RT and 50.
Modifier GA-Waiver of Liability Issued as required by payer policy
Added the third paragraph indicating Modifier GA should not be billed with other liability modifiers.
Site Specifying Modifiers
In the Laterality section, added the sixth paragraph to describe the correct criteria to bill bilateral surgical procedures and to describe the correct selection of the related diagnosis code to reflect a bilateral diagnosis code if one is present for the diagnosis category.