Payment Policy Updates December 2021

November Payment Policy Updates

The following payment policies received their annual review with no changes to policy content:

• Anesthesia Guidelines
• Anesthesia Modifiers
• Drugs Administered in a Physician Ofice
• Modifier 51 – Multiple Procedures
• Modifier 90 – Reference (Outside) Laboratory
• Multiple Diagnostic Ophthalmology Services Reduction

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

• Allergen Immunotherapy (95165) Unit Limits
  • Removed Ofice visit codes
• Contract Exclusions/Disallowed Charges-Inpatient and Outpatient Facility Services
  • In response to provider requests, expanded and clarified the policy content to reflect non-reimbursable services more accurately
• Drug Assay Services/Urine Drug Testing
  • Revised the opening paragraphs of the Definitive/Quantitative Drug Class section in the policy
• Hospital or Hospital System Readmissions
  • Added back exceptions that were inadvertently removed from the prior policy update including newborn/neonatal care, infants (children less than 12 months old), and pediatric oncology
• Maternity Services
  • Clarified the description under delivery including postpartum care section of the policy to identify what services are included 

Log into the secure provider portal to view the full policy details.

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