Here are the latest updates to our payment policies. You’ll need to log in to see the policy updates.
- Group Psychotherapy Services (90853)
- Modifier 63 - Procedure Performed on Infants Less than 4kg
- Multiple Deliveries/Births
All received an annual review; no changes made to these three policies
- Modifier 23 - Unusual Anesthesia
- In the policy section, third paragraph, clarified that the modifier is used only with general or monitored anesthesia codes
- In the fourth paragraph, clarified that the surgeon does not bill an additional separate anesthesia code along with the surgery code
- Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician in the Post-Operative Period
- In the policy section, first paragraph, added that this modifier is valid for eye exam codes as well
- In the second paragraph, stated that the diagnosis submitted should support why the exam is not related to the surgical procedure
- Modifier 47 - Anesthesia by Surgeon
In the Policy section, second paragraph, clarified how this modifier is to be used
- Modifier 57 - Decision for Surgery
In the Policy section, second paragraph, further clarified the global period for a minor surgical procedure
- Modifier TH - Obstetrical treatment/services
In the Policy section, third paragraph, removed routine from the statement; this modifier is not used on any postpartum visit
- Drug Assay Services
- Major revisions going live as of dates of service February 1, 2018 and after
- In the definitions section, the definition for Presumptive Drug Class Procedures has been clarified
- In the policy section, the following edits were made:
- Presumptive Class Procedures Section:
- Added new code 0007U (effective 08/01/2017) with its code description and frequency limitations
- Added the final paragraph in this section to state only one of these codes will be reimbursed per day, per customer (new edit)
- Definitive drug class procedures section:
- First paragraph, the individual drug tests, codes 80320-80377 and 83992 will no longer be reimbursed as of date of service 02/01/2018 and after.
- Drug testing codes G0480-G0483 and G0659, based on drug classes, will be the only definitive drug testing codes that will be reimbursed.
- We added a final paragraph on page 5 that states only one of these G-series codes will be paid per day, per customer (new edit).
- We published the 90 day notice to providers in the November 2 Provider News
- National Drug Code (NDC) Billing Guidelines-Outpatient Facility Claims
Clarified the billing instructions at top of page 3
- Durable Medical Equipment (DME)/Home Medical Equipment (HME)
In an attempt to provide further clarity, we expanded the policy as follows:
- In the definitions section, added definitions for “Rental Only Services” and “Purchase Only Services”
- In the policy section, added the introductory paragraph to introduce the three categories of DME that are edited:
- Rental To Purchase Services - expanded the paragraph explaining the change in supplier situation
- Rental Only Services - added this as a new paragraph to discuss the differences in the rental items
- Purchase Only Services - added as a new paragraph to explain what these services include
- Also in the policy section, created a new section heading (Modifiers) to call out the instructions for the correct modifier usage. Created another new section heading (Units of Service) to call out the correct submission of units
- At the end of the policy section, added a link to the listing of DME codes that make up the three sections discussed in the policy