Here are the latest updates to our payment policies. You’ll need to log in to see the policy updates.
May 6, 2021
Add-On Codes
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim forms. In the
codes/coding guidelines section, a fifth bullet was added in the sub-section of the American Medical Association CPT Professional Codebook on how to identify primary/parent codes when no parenthetical note is found after the add-on code.
Inpatient Acute Transfers from DRG Hospitals
Clarified in the purpose statement that the policy applies to facility services billed on a UB-04/CMS-1450 paper claim form
or 837I electronic claim form.
Multiple Diagnostic Cardiovascular Services Reductions)
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500
or 837P electronic claim forms. Added link to the CMS National Physician Fee Schedule.
Multiple Diagnostic Imaging Reductions
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic
claim forms. Added link to the CMS Medicare National Physician Fee Schedule.
Modifier JW-Drug Amount Discarded/Not Administered to Any Patient
Clarified the purpose statement to indicate that the policy pertains to professional services billed
on a CMS-1500 or 837P electronic claim forms.
Serious Adverse Events-Inpatient Facility Services
Clarified in the purpose statement that the policy applies to facility services billed on a UB-04/CMS-1450 paper claim
form or 837I electronic claim form. Added clarification to the definitions Never Event and Hospital Acquired Conditions. In the policy section, expanded the second paragraph in the section Hospital Acquired Conditions (HAC) and Never Events and revised
the Present on Admission (POA) Indicators paragraphs. In the codes/coding guidelines section removed the ICD-10 CM diagnosis code T81.500A.