Payment Policy Updates

  • Here are the latest updates to our payment policies. You’ll need to log in to see the policy updates.

    March 21, 2019

    The following policies received their annual review without any changes to the policy content:

    The following policies received their annual review and had revisions as noted:

    A new section was created at the end of the policy statement titled “Unit billing for Timed Codes.” It references the CPT guidelines used for this policy to determine when a unit of time has been reached and therefore billable.

    March 7, 2019

    The following is a NEW Payment Policy effective with claim process date of June 9, 2019 and after.

    Blood Draw/Venipuncture with Office Visit E&M Code

    Routine blood draws/venipunctures (CPT code 36415) will no longer be separately reimbursable when the service is billed on the same date of service as an E&M office visit service (CPT codes 99201-99215) by the same provider or provider group. Modifier 59, XS, XP, XE or XU will not override/bypass the denial of the blood draw/venipuncture code when billed with an E&M office visit on the same date of service.

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