July 3, 2025
The following policies received their annual review with no changes:
The following policies received their annual review with the changes noted below:
Modifier AS
- Removed from the exceptions section: Oregon providers: Reimbursement will be 20% of the provider’s applicable Fee Schedule allowed amount for the primary surgery.
Modifier 79
- From the policy section paragraph 4: removed the statement indicating modifier 79 should not be applied to “Ambulatory Surgery Center (ASC) facility services.”
Prolonged Services for Labor Management (cmi_171502)
- In the codes/coding guidelines section revised conjunction related codes. Also revised the coding description for G2212.
NEW PAYMENT POLICIES: effective October 3, 2025:
Intraoperative Neurophysiologic Monitoring (IONM) Billing
- Professional oversight in IONM can be provided in two ways:
- Monitoring oversight within the Operating Room (OR) (CPT code 95940).
- Monitoring oversight remotely outside of the OR, requiring a real-time remote connection (CPT code 95941/HCPCS code G0453).
- Effective with claim dates of service on and after October 3, 2025, "incident to" services provided by an assisting physician, anesthesiologist, or certified technician to the monitoring physician will not be reimbursed. Monitoring
oversight will only be reimbursed to the monitoring physician. Procedure codes 95940, 95941, and G0453 are classified as global or "complete" services and do not have professional and technical components. Modifiers 26 and TC do not apply to
these codes and will be denied if submitted.
Intensity Modulated Radiation Therapy (IMRT)/Proton Beam Therapy Planning and Treatment Coding – Outpatient Facility claims
- Effective with claim dates of service on and after October 3, 2025, several CPT procedure codes will be considered inclusive to CPT procedure code 77301 (IMRT planning) when submitted by the same facility within 30 days before or after the IMRT planning
procedure. These codes include: 77014, 77280, 77285, 77290, 77295, 77306, 77307, 77313, 77317, 77318, 77321, 77331, and 77370.
- This policy aligns with the American Society for Radiation Oncology ASTRO guidelines and the Centers for Medicare and Medicaid Services (CMS) Claims Processing Manual on how to correctly bill for IMRT services. These codes should not be reported
separately if performed as part of developing an IMRT treatment plan.