Here are the latest updates to our payment policies. You’ll need to log in to see the policy updates.
March 4, 2021
The following payment policies received their annual review:
After-Hours Services
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form.
Blood Draw (Venipuncture) – 36415
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form.
Claims Editing System (CES) - Exceptions
Minor clarification to the purpose statement.
Facility Fees: Clinic Services, Professional Fees and Specialty Services-Treatment Room
Indicated in the policy section that the non-reimbursement of the revenue codes in the policy is a provider write-off. Added an exception to indicate that during the declared public health emergency, the COVID-19 vaccine administration codes will be reimbursed until the public health emergency is declared over or Premera decides to no longer reimburse these vaccine administration codes.
Home Birth Kit Supplies (S8415)
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form.
Modifier 79-Unrelated Procedure/Service by Same Provider during Post-operative Period
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form.
Modifier 80, 81, 82 – Assistant Surgeons (Physician)
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form.
Added a link to the CMS National Physician Fee Schedule. Clarified that modifiers 80/81/82 and modifier AS can’t be billed on the same claim by the same provider on the same date of service. Added an exception that this policy doesn’t apply to providers that are paid on an ASC-APC payment methodology.
Modifier AS-Physician Assistant, Nurse Practitioner or Clinical Nurse Specialist Services for Assistant at Surgery (Non-Physician)
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form.
Added a link to the CMS National Physician Fee Schedule. Clarified that modifiers 80/81/82 and modifier AS can’t be billed on the same claim by the same provider on the same date of service. Added an exception that this policy doesn’t apply to providers that are paid on an ASC-APC payment methodology.
Modifier SL-State Supplied Vaccine
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form.
Clarified that the vaccines in question are those listed on the current Washington State Vaccine Association assessment grid.
New and Established Patient Guidelines
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form.
Prolonged Services for Labor Management (Codes 99354-99357)
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form. Clarified in the policy section that the codes are “add-on codes.”