June 1, 2023
The following policies received their annual review with no changes:
The following policies received their annual review with the changes noted below:
Drug Assay Services/Urine Drug Testing
- At the end of the policy section, noted that PLA codes 0143U through 0150U are terminated effective July 2023.
- In the codes/coding guidelines section, under the Additional Proprietary Lab Analysis (PLA) code section, moved code 0328U after code 0093U.
- Created separate section for code 0143U-0150U to indicated codes are valid through June 30, 2023, dates of service. Added a termination date of July 1, 2023, to each of these codes.
Modifier 57 – Decision for Surgery
- Added a minor clarification in the second paragraph of the policy indicating that the preoperative period of a major surgery is defined as the day before and the day of the surgical procedure.
Modifier 76 – Repeat Procedure by the Same Provider
- Added the third paragraph in the policy section to indicate that when the same service/procedure is repeated by a different provider, modifier 77 must be appended to be reimbursed.
Modifier 77 – Repeat Procedure by Another Provider
- Added additional policy references cited in the policy section.
- Added the third and fourth paragraphs in the policy section to identify when modifier 77 isn’t appropriate to use.
Modifier CQ – Physical Therapy Assistant and Modifier CO-Occupational Therapy Assistant
- Revised the policy title.
- Reference in the policy to outpatient physical therapy and occupational therapy services was changed to physical medicine and rehabilitation services to reflect their classification more accurately as listed in the CPT Codebook.
- In the plan of care modifiers section of the policy, inserted the paragraph which identifies the source of the list of always therapy codes that require a plan of care modifier and provided a link to that source.
- At the end of the policy section, removed the effective date of the reimbursement percentage due to the date being over a year.
Modifier TH – Obstetrical treatment/services
- Due to changes/revisions to the Evaluation and Management (E&M) codes effective January 1, 2023, the reference to home visits was changed to home or resident visits in the policy section.
- In the codes/coding guideline section, revised the code descriptions for the new patient home or residence visits and the established patient home or residence visits codes to reflect the revised code descriptions.
Multiple Deliveries/Births
- Removed two single birth diagnosis codes from the diagnosis code list.
COVID-19 Testing: Diagnostic, Surveillance and Over the Counter
- CORRECTION: A correction was made to the date that over-the-counter (OTC) COVID-19 tests will no longer be reimbursed. OTC tests purchased on and after May 12, 2023, will no longer be reimbursed as member submitted claims due to the end of the Public Health Emergency on May 11, 2023.
Modifier 23 – Unusual
Anesthesia
- CORRECTION: Minor clarification to the fourth paragraph
indicating the performing surgeon would NOT append modifier 23 to
the main surgical procedure but continue to append modifier 47 only to the
surgical procedure when they perform general or monitored anesthesia along with
the surgical procedure.