June 6, 2024
Policies receiving their annual review with no changes:
Policies receiving their annual review with the following changes:
Abortions-Facility Services
In the Policy section, removed the last paragraph concerning all other abortions did not need to append modifiers or include a condition code.
Abortions-Professional Services
In the Policy section, removed the last paragraph which indicated that other abortion procedures do not require a modifier.
Allergen Immunotherapy (95165) Unit Limits
In the Policy, minor clarification made to the fifth paragraph to indicate billing for separate and distinct services unrelated to the allergen immunotherapy may be submitted with an E&M service.
Anesthesia Guidelines
- In the Policy section under Related care, added the first paragraph indicating that E&M services submitted one day preoperatively, on the same date of or one day postoperatively will be considered included in the anesthesia service.
- Added last paragraph in the Codes/Coding Guidelines section on how to report anesthesia when multiple anesthesia procedures are performed.
Contract Exclusions/Disallowed Charges – Inpatient and Outpatient Facility Services
Added and/or Modified (BOLDED) the following sections to provide for additional clarification on non-reimbursable services:
- Nursing Services:
- Removed the bullet: Injections/vaccinations, subcutaneous and intramuscular
- Added the bullet: Medication administration including vaccines, subcutaneous and intramuscular
- Removed the bullet: “Bedside respiratory and pulmonary services”
- Respiratory Services:
- Revised the bullet: “Bedside respiratory and pulmonary services (ex. management of nebulizers/breathing treatments, mechanical chest physiotherapy, swallow testing, IPPB therapy, Nebulizer treatments)” to read “Pulmonary services such as management of nebulizers/breathing treatments, mechanical chest physiotherapy, swallow testing, IPPB therapy, Nebulizer treatments
- Pharmacy Services:
- Removed the bullet: “Anesthetic related drugs administered as part of or during the time of a procedure (e.g., Propofol)”
- Added bullet: “Anesthetic products related to anesthesia maintenance, anesthesia related to surgical procedure and anesthetic reversal agents”
Durable Medical Equipment (DME)/Home Medical Equipment (HME)
- In the Policy section under the Unlisted DME and Miscellaneous Supplies and Services section, added the first paragraph which was moved up from the Related Services section.
- New codes added effective with dates of service on and after April 1, 2024: E0468, E2104 and E2298
- Removed code effective with dates of service on and after April 1, 2024: A7045
Maternity Services
- In the Confirmatory Visit section, added the third paragraph to indicate maternity care begins when the pregnancy has been confirmed
- In the Global Obstetric Package section, added the last paragraph to indicate circumstances when individual maternity services must be billed
- In the Antepartum Care only section, in the second paragraph, indicated that the last date of service should be billed with one unit
- In the Postpartum Care only section,
- in the second paragraph indicated that the last date of service should be billed with one unit and
- in the third paragraph, revised the wording of the first bullet
- In the Unlisted Maternity Care and Delivery section, in the last paragraph, added the last sentence indicating that documentation must describe the specific services that are represented by the unlisted procedure code
- Added a new section “Maternity Complication Services and High-Risk Pregnancies” which discusses guidelines for billing for a high-rick pregnancy or maternity complications
Modifier 22-Increased Procedural Services
- In the Policy section, expanded upon the sixth paragraph to indicate that is supporting documentation for appending modifier 22 is not received, the procedure will be reimbursed at the provider’s contractual allowed amount with no increase.
- Added a new section at the end of the policy “Maternity Complication Services and High-Risk Pregnancies” which discusses scenarios where appending modifier 22 would be appropriate.
Modifier NU – New DME Equipment and Modifier NR – New DME Equipment When Rented
Created a new section in the Policy “Replacement of a DME, orthotic or prosthetic item” and moved the existing paragraphs into this new section.
Modifier RA – Replacement of a DME, Orthotic or Prosthetic Item
Revised the second and third paragraphs in the Policy section to reflect the correct guidelines for appending modifiers for Rental and Purchased replacement DME items.
Modifier RR – Durable Medical Equipment (DME) Rental, Modifier KR – Rental item-partial month and Modifier LL – Lease/Rental
Created a new section in the Policy “Replacement of a DME, orthotic or prosthetic item” and moved the existing paragraphs into this new section.
Robotic Surgical System and Computer Assisted Navigation Codes (S9200, 20985, 0054T and 0055T)
Added the last paragraph in the Policy section which states that appending modifier 22 to the surgical procedure to represent the use of robotic or computer assisted surgical techniques is not a guarantee of additional payment.