August policy updates
The following policies received their annual review with no policy changes:
The following policies received their annual review with the changes noted below:
- Acupuncture
- Paragraph from the modifier 25 payment policy added in the codes/coding guidelines section indicating that appending modifier 25 does not automatically allow for payment unless the documentation supports a separate and distinct nature of the
E&M service.
- Abortions - Facility
- Broadened the policy to cover ALL abortions.
- Abortions - Professional
- Broadened the policy to cover ALL abortions.
- Group Psychotherapy Services (90853) (90-day notice)
- Effective with claim process dates December 7, 2022, all professional services billed by a medical group/clinic, facility, or individual will be subject to the policy criteria of one unit per date of service per member per provider regardless
of the length of the therapy session represented by code 90853.
- New Policy - Place of Service Codes (90-day notice)
- Creation of new policy to educate providers on the various Place of Service (POS) codes to use on a professional claim form based on the location where the service was rendered. Some special coding criteria on how to correctly code POS codes for certain situations also described. Policy is effective with claim process dates on and after December 7, 2022.