Payment Policy Updates June 2020

Here are the latest updates to our payment policies. You’ll need to log in to see the policy updates.

June 4, 2020

The following policies received their annual review with no changes made:

• Modifier 22 – Increased Procedural Services
• Modifier 53 – Discontinued Services
• Modifier 78 – Unplanned Return to the OR for a Related Procedure
• Unlisted, Non-Specific and Miscellaneous Procedure Codes

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

• Ambulatory Surgery Center Facility Services-Modifiers SG and Place of Service 24
  • Revised policy section to be more reflective of the actual claim edit.
• Durable Medical Equipment
  • Updated link to the file of capped DME services.
• Modifier 50-Bilateral Procedure
  • Added a cross reference to Modifier 62 – two surgeons payment policy.
  • Added a paragraph that two surgeons working together on a bilateral procedure should bill their services with modifier 62.
• Modifier 52 – Reduced Services
  • Added a cross reference to maternity services payment policy.
• Modifiers 54/55/56 – Surgical Care Only, Postoperative Management, Preoperative Management Only
  • Added clarification that the documentation in the patient’s medical record should document the portion of the global procedure rendered by each provider.
• Telehealth/Telemedicine Services
  • Revised definitions of “Originating Site” and “Store and Forward”.
  • In the exceptions section, the termination date previously entered for the removal of the exceptions noted was removed. the exceptions will remain active during the COVID-19 public health emergency.

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