November 7th, 2024
The following policies received their annual review with no changes:
The following policies received their annual review with the changes noted below:
Durable Medical Equipment/Home Medical Equipment
- In the Unlisted DME and Miscellaneous Supplies and Services section of the Policy, revised the first paragraph to indicate that a description of the unlisted service(s) is required, regardless of billed charge, and should be entered into either Box 19 or Box 24 on the Professional claim form
- Updates to the code list in the embedded link include the following:
- Codes previously labeled as “Capped Rental (RR)” have been revised to now read “Capped Rental (RR) or Outright Purchase (NU) to reflect requirements in the policy; Only one of these modifiers may be billed and allowed on the codes indicated
- Code A4608 – status was changed to Oxygen Rental only (RR)
- Code A7045-CORRECTION-Code is still active and should not have been removed in prior 05/14/24 policy update
Global Surgery
In the Policy section, the following updates were made:
- In the Services Included in the Global Surgery Payment section, the last five bullets are added.
- In the modifier 25 section, in the second paragraph, added the global day periods for both the major and minor procedures
- In the modifier 57 section, added the 90-day global period statement to major surgery and added the second paragraph
- In the modifier 76 section, deleted the reference to documentation in the first paragraph since it was also stated in the second paragraph
- In the modifier 78 section, deleted a paragraph that referenced adjustment to reimbursement to reflect an unplanned return to the operating room
- In the modifier 79 section, added the second paragraph
- In the Multiple Procedure Reductions section, added that Multiple Procedure Flag indicator code “2” is used to identify those procedures that are subject to multiple procedure reductions
Medically Unlikely Edits (MUEs)/Maximum Units of Service
- In the section MAI 1-Claim line MUE Edit, added the second paragraph to indicate how the units that exceed the MUE maximum will be processed
- In the section MAI 2 and MAI 3-Date of Service MUE edit, added the second paragraph to indicate how the units that exceed the summed MUE maximum will be processed
- In the third paragraph from the bottom of the Policy, summarized how the Practitioner, Facility Outpatient and DME MUEs are assigned based on anatomic considerations
Modifier SL-State Supplied Vaccine
Removed the SARS-CoV2 vaccine procedure codes that were terminated 11/01/2023.
Multiple Diagnostic Cardiovascular Services Reductions
Removed the Exceptions for Blue Card Home and Host claims and FEP claims
Multiple Diagnostic Imaging Reductions
Removed the Exceptions for Blue Card Home and Host claims and FEP claims.
Multiple Diagnostic Ophthalmology Services Reductions
Removed the Exceptions for Blue Card Home and Host claims and FEP claims.
Urine Drug Testing and Drug Assay Services
In the Codes/Coding Guidelines section, removed codes 0143U-0150U which were deleted effective 07/01/23.
Screening Services with Evaluation and Management (E&M) Services
In the Exceptions section, the following updates were made:
- Removed statement “Not applicable for Alaska member due to state mandate on coverage for prostate and cervical cancer detection” as the mandate criteria does not reference when billed with E&M services but only addressed the screening services.
Serious Adverse Events-Inpatient Facility Services
In the Hospital Acquired Conditions (HACs) and Never Events section of the Policy, revised the third paragraph to indicate members are held harmless and added a link to the CMS listing of HACs.