Here are the latest updates to our payment policies. You’ll need to log in to see the policy updates.
May 20, 2021 Payment Policy Updates
Ambulatory Surgery Center (ASC) Facility Services: Modifier
SG and Place of Service 24
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form.
Durable Medical
Equipment (DME) and Home Medical Equipment (HME)
Added payment policy modifier RA to the cross-reference section. Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form.
Modifier 22 – Increased
Procedural Services
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form. Added second paragraph in policy section to identify which codes can and cannot be appended with modifier 22.
Modifier 52 – Reduced
Services
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form.
Modifier 53 –
Discontinued Procedure
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form.
Modifier 54, 55, 56 –
Surgical Care Only, Postoperative Management Only, Preoperative Management Only
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form. Added link to the CMS National Physician Fee Schedule in the policy section.
Modifier 78 - Unplanned return to the
Operating Room by the Same Physician for a Related Procedure During Post-operative period
Added cross reference to modifier 76 payment policy. Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form. Added link to the CMS National Physician Fee Schedule.
Added paragraph referencing Modifier 76 for repeat of the same identical procedure.
Unlisted, Non-specific
and Miscellaneous Procedure Codes
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form.