The following Payment Policy has been withdrawn:
Blood Draw/Venipuncture with Office Visit E&M CodePremera has chosen to not move forward with enforcing the Payment Policy titled “Blood Draw/Venipuncture with Office Visit E&M Code” that was to become effective as of 06/09/2019. The policy has been removed from the external Provider portals and at this time no future editing will be developed for this coding scenario.
Here are the latest updates to our payment policies. You’ll need to log in to see the policy updates.
AcupunctureRemoved the footnotes and combined the paragraphs on new and established E&M visits into a single paragraph. Added references in the Codes/Coding Guidelines section to key information from Payment Policies for New and Established Patients and Modifier 25.
Manipulation ServicesRemoved footnotes in Policy statement. Clarified the Policy section to indicate that E&M services must be billed in compliance with New/Established patient guidelines and consistent with modifier 25 policy guidelines.
Modifier 26-Professional ComponentAdded new section, definitions, and included a statement on professional component, technical components, global service and standalone procedure codes that are discussed in the policy section.
In the policy section, the following changes were made:
Added new section codes/coding guidelines discussing the PC/TC indicator flags, identifying which can/cannot be billed with 26/TC modifiers; added some statements on inappropriate use of these modifiers.
Modifier TC – Technical ComponentRevisions called out in Modifier 26 policy apply to this policy as well
Modifier SU – Procedures Performed in Physician’s Office (Facility and Equipment)Revised paragraph 2, pulling out the first sentence and adding it as a separate paragraph 3
Multiple Endoscopy Procedure ReductionsAdded Payment Policy Modifier 51 as a resource in the cross-reference section and referenced Modifier 51 in the policy.
Multiple ModifiersAnnual review; no changes
Multiple Surgical ReductionsAdded Payment Policy Add-On Codes and Modifier 51 in the cross-reference section. Referenced Modifier 51 in the surgical procedures subsection on the policy statement. Referenced the need for an appropriate primary code when billing an add-on code in the add-on surgical procedures subsection in the policy statement. Referenced Modifier 51 in the first paragraph in the exempt procedures subsection in the policy statement.
Email this article
Back to News