Payment Policy Updates from January 2023

The following payment policies received their annual review with no changes:

• Modifier 25 – Significant, Separately Identifiable Evaluation & Management (E&M) Service on Same Day of Procedure or Other Service
• Modifier 58 – Staged or Related Procedure or Service by Same Physician or Other Qualified Healthcare Professional during Postoperative Period
• Modifier 91 – Repeat Clinical Diagnostic Laboratory Test
• Robotic Surgical System and Computer Assisted Navigation Codes (S2900, 20985, 0054T and 0055T)
• Teledentistry Services

The following payment policies received their annual review with the changes noted below:

• Evaluation and Management (E&M) Visit Billed with Preventive Medicine Examination
  Added third paragraph to indicate that the appending of modifier 25 is not a guarantee of payment. In the Codes/Coding Guidelines section of the policy, updated the code descriptions in the sections Home Services (new and established) and Preventive Medicine Services (effective January 1, 2023).
• Group Psychotherapy Services (90853)
  Correction: One unit will be applied to code 90853 effective with “dates of service” December 7, 2022, on and after rather than process dates.
• Modifier 22 – Increased Procedural Services
  Clarified modifier 22 should not be appended to services rendered to neonates and infants with a body weight of less than 4 kg.
• Modifier 54, 55, 56 – Surgical Care Only/Postoperative Management Only/Preoperative Management Only
  Inserted the phrase “or other qualified healthcare professional” as a potential provider of services.  Added the second bullet under Modifier 54.
• Screening Services with Evaluation and Management (E&M) Services
  Added the last paragraph in the policy to indicate appending modifier 25 to the E&M must be documented in the notes as a separate and distinct E&M service.
• Site Specifying Modifiers
  Created a new section in the policy for laterality.
• Telehealth/Telemedicine Services
  Removed effective dates on modifiers that were over a year old.

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