Here are the latest updates to our payment policies. You’ll need to log in to see the policy updates.
September 17, 2020
Summary of Policy Updates:
Modifier 57-Decision for Surgery
Clarified the purpose statement to indicate that the policy pertains to professional services billed on CMS-1500 or 837P claim forms.
Modifier 63-Procedure performed on infants less than 4kg
Clarified the purpose statement to indicate that the policy pertains to professional services billed on CMS-1500 or 837P claim forms. In the policy section, called out the code exceptions in the medicine/cardiovascular category of codes that can also be billed with Modifier 63.
Modifier 66-Surgical Team
Clarified the purpose statement to indicate that the policy pertains to professional services billed on CMS-1500 or 837P claim forms.
Modifier 73-Discontinued ASC Procedure Prior to Administration of Anesthesia
Clarified the purpose statement to indicate that the policy pertains to professional services billed on CMS-1500 or 837P claim forms.
Modifier 74- Discontinued ASC Procedure After Administration of Anesthesia
Clarified the purpose statement to indicate that the policy pertains to professional services billed on CMS-1500 or 837P claim forms.
Modifier 76-Repeat Procedure by the Same Provider
Clarified the purpose statement to indicate that the policy pertains to professional services billed on CMS-1500 or 837P claim forms.
Modifier 77-Repeat Procedure by Another Provider
Clarified the purpose statement to indicate that the policy pertains to professional services billed on CMS-1500 or 837P claim forms.
Modifier TH-Obstetrical Treatment/Services
Clarified the purpose statement to indicate that the policy pertains to professional services billed on CMS-1500 or 837P claim forms. In the codes/coding guideline section, added the codes for antepartum and postpartum visits.
Multiple Births/Deliveries
Clarified the purpose statement to indicate that the policy pertains to professional services billed on CMS-1500 or 837P claim forms. In the Codes/Coding Guideline section, added the codes for antepartum and postpartum visits.
Multiple Surgical Reductions
Clarified the purpose statement to indicate that the policy pertains to professional services billed on CMS-1500 or 837P claim forms. Added a link to CMS National Physician Fee Schedule. In the exception section, added two exceptions, one that ASCs are exempt from the policy and the other was 2 codes exempt from multiple procedure reductions.