February Policy Updates
Evaluation
and Management Services Visit Billed With Preventive Medicine Examination
Added clarification to the second paragraph in the policy section addressing the correct use of modifier 25 on an office visit code billed on the same date of service as a preventive medicine examination. Removed code 99201 which was deleted effective January 1, 2022.
Modifier
22-Increased Procedural Services
Clarified the correct way to code for additional work required for anesthesia services is to bill with additional time units or physical status modifiers rather than appending modifier 22 to the anesthesia service.
Modifier
25 – Significant Separately Identifiable E&M Service on Same Day of
Procedure or Other Service
Added clarification on the correct use of modifier 25 on evaluation and management (E&M) services indicating that appending modifier 25 does not result in automatic reimbursement unless supported by the documentation in the member's medical record as
a separately identifiable service.
Modifier
58 – Staged Procedure
Annual review; no changes.
Modifier
91 – Repeat Clinical Diagnostic Laboratory Test
Minor clarification added to the end of the first paragraph in the policy statement.
Robotic
Surgical Systems and Computer Assisted Navigation Codes
Deleted the paragraph indicating the policy applies to facility claims as that is stated in the purpose section of the policy.
Screening
Services with Evaluation and Management Services
Clarified in the policy statement that the documentation must support the need for a separately identifiable E&M office visit when billed in conjunction with the screening test.
Site
Specifying Modifiers
Clarified that left and right modifiers must match the laterality of the ICD-10 CM diagnosis code and that the left and right modifiers are appended only when the procedure pertains to one anatomic side but not both.
Teledentistry
Services
Added clarification in second paragraph of the policy section that code D0190 can be performed via an audio-only telecommunications system. Added the last bullet in the documentation section of the policy.
Telehealth/Telemedicine
Services
Updated the modifier section of the policy to include new telehealth modifiers effective January 1, 2022: modifiers 93, FQ and FR.
March Policy Updates
The following payment policies received their annual review with no changes:
Add On Codes
Inpatient Acute Transfers
from DRG Hospitals
Modifier JW– Drug Amount
Discarded/Not Administered to Any Patient
Multiple Diagnostic Cardiovascular
Services Reductions
Multiple Diagnostic
Imaging Reductions
The following payment policies received their annual review and changes/updates made are as follows:
Ambulatory
Surgery Center (ASC) Facility Services
Clarified the correct use of the place of service code 24 and the modifier SG.
New Policy: COVID-19 Testing for
Occupational, Vocational, School, Travel Or Public Health Purposes
New payment policy on diagnostic testing, surveillance testing and over-the-counter (OTC) home test kit testing.
Durable
Medical Equipment/Home Medical Equipment
Clarified that the "rental to purchase equipment" classification includes "purchase or rental to purchase equipment." Updated the list of codes in the link in the policy to reflect the 2022 DME CMS fee schedule.
Organ Acquisition Costs (Medicare Advantage
Benefits Policy Only)
Added exception that acquisition costs of kidneys are excluded from reimbursement.
Serious Adverse
Events – Inpatient Facility Services
In the hospital acquired condition section of the policy, clarified that the plan will not reimburse diagnosis codes on the CMS hospital-acquired conditions list or a never event diagnosis code. In the "present on admission" section of the policy, identified
where to find the coding guidelines for present on admission indicators. In the codes/coding guidelines section of the policy, minor revisions to the present on admission indicator code descriptions.