Payment Policy Updates February 2019

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

February 21, 2019

The following policies had Annual Reviews and no changes were made to the content:

• Global Surgery
• Maternity Services
• Modifier 33 – Preventive Services
• Modifier 59 – Distinct Procedural Service
• Modifier KX – Requirements specified in the medical policy have been met
• Modifier NU – New DME Equipment and Modifier NR – New DME Equipment when Rented
• Modifier RA – Replacement of a DME, Orthotic or Prosthetic item
• Modifier RR – DME Rental, Modifier KR – Rental item-partial month and Modifier LL – Lease/Rental
• Modifiers XE, XS, XP and XU – Separate Encounter, Separate Structure, Separate Practitioner and Unusual Overlapping Service

The following policy received updates as part of the annual review:

Telehealth/Telemedicine Services

• The existing sub-section “Synchronous/Asynchronous Communication” was split into 2 separate sections
• In the “Asynchronous Communications” section, such allowed services can be either provider generated, or member generated services. Member generated codes are new as of 01/01/2019 (G2010) and are payable. Provider generated codes are now payable as of 01/01/2019 dates of service
• In the sub-section “Telehealth Modifiers”, the newly created modifier G0 (G zero) was added for telestroke services, effective with dates of service 01/01/2019
• In the section “Codes/Coding Guidelines”, the now payable asynchronous codes for both provider generated and member generated “store and forward” items were added.

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