October 5, 2023
The following payment policies received their annual review with no changes:
The following payment policies received their annual review with the changes noted below:
Abortions – Facility Services
- In the Policy section, under the Inpatient Facility Claims Only subsection, added four ICD-10 PCS (Procedure Coding System) procedure codes to the bottom of the list for ectopic abortions.
Acupuncture
- Expanded the maximum units allowed on the add-on acupuncture codes 97811/97814 to 2 units per provider, per member, per day per Center for Medicare and Medicaid Services (CMS) Medically Unlikely Edits (MUE).
- Clarified the Current Procedural Terminology (CPT) coding guidelines when both time-based acupuncture services and needle insertion services are performed.
- Created a separate paragraph to indicate that the needles used in acupuncture and needle insertion services are not separately billable as a supply code.
- Added a paragraph indicating National Correct Coding Initiative (NCCI) edits will be applied when BOTH acupuncture and needle insertion services are billed on the same date of service, for the same member by the same provider.
Allergen Immunotherapy (96165) Unit Limits
- Revised the first paragraph in the Policy section into bulleted points.
Durable Medical Equipment (DME)/Home Medical Equipment (HME)
- Created a new subsection in the policy section titled “Replacement of a DME, orthotic or prosthetic item” to describe the correct usage of Modifier RA.
- In the Modifiers subsection of the Policy, created a new section for Replacement Modifier.
Modifier RA – Replacement of a DME, Orthotic or Prosthetic item
- Added the second paragraph in the Policy section which describes when to append Modifier RA for a rented piece of replacement DME.
- Added the third paragraph in the Policy section which describes what modifier to append when the replacement DME is purchased outright.
- Added the new section Codes/Coding Guidelines which identified the replacement, rental and purchase modifiers.