The following Payment Policy has been withdrawn: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.
The following June Payment Policies received their Annual Review with NO changes:
The following June Payment Policies received their Annual Review and HAD changes as summarized below (see specific policy for details):
The following payment policies received their Annual Review with NO changes:
The following Payment Policies received their Annual Review and HAD changes as summarized below (see specific policy for details):
Add-On CodesIn the POLICY and EXCEPTION sections, added reference to the CPT Codebook instructions which indicate certain add-on codes can be billed either on the same date of service as the primary code or on a different date of service than the primary code.
Drug Assay ServicesAdded references to the new Proprietary Lab Analysis (PLA) codes added for 2019.
Inpatient Acute Transfers from DRG HospitalsClarified that the transfers are from one acute care facility to another acute care facility.
Modifier JW – Drug Amount discarded/not administered to any patientRevised the POLICY statement to make it more readable and added instructions on NDC code billing. Created a new sub-section in the POLICY statement for “Adverse Drug Reactions”.
Serious Adverse Events – Inpatient Facility ServicesRemoved references to ICD-9 coding as it’s no longer appropriate (run out was the end of 2016). Deleted the section under “Present on Admission (POA) Indicators” as Providers are required to submit POA indicators on their claims.
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