Payment Policy Recent Updates

Payment policy title: (See the links for full policy criteria)	Update:	Policy number:	Policy approval date:
Consultation Code Service	Annual review, no changes	377	Annual review, approved Oct. 20, 2016
Elective Abortions – Facility Services	Added new ICD-10 procedure codes Added requirement of modifier G7 to the listed CPT procedure codes	F003	Annual review, approved Oct. 20, 2016
Elective Abortion – Professional Services	Annual review, no changes	383	Annual review, approved Oct. 20, 2016
Modifier 26 – Professional Component	Added description for the professional or technical component (PC/TC) indicators noted in the policy	151	Annual review, approved Oct. 20, 2016
Modifier GA – Waiver of Liability Issued as Required by Payer Policy	Annual review, no changes	371	Annual review, approved Oct. 20, 2016
Modifier TC – Technical Component	Added description for the professional or technical component (PC/TC) indicators noted in the policy	152	Annual review, approved Oct. 20, 2016
Serious Adverse Events	Revised the ICD-10 CM diagnosis descriptions to reflect 2017 code revisions Updated links to the present on admission (POA) guidelines	F001	Annual review, approved Oct. 20, 2016
Urgent Care Services Reimbursement	Annual review, no changes	369	Annual review, approved Oct. 20, 2016
Anesthesia Modifiers	Added reimbursement percentage(s) to the policy	382	Annual review, approved Oct. 20, 2016
Annual Health Review (G0438/G0439)	Quality improvement program terminating Dec. 31, 2016; policy criteria is effective through Dec. 31, 2016 As of Jan. 1, 2017, policy criteria no longer valid	384	Annual review, approved Sept. 14, 2016
Durable Medical Equipment Rental to Purchase	New policy, effective Dec. 11, 2016 Modifiers required in order to identify the correct status of durable medical equipment, whether new, used, or rental Guidelines provided on how to identify monthly and daily rentals as well as a purchase of new or used equipment	403	Annual review, approved Sept. 14, 2016
Modifier 22 – Increased Procedural Services	Added reimbursement percentage(s) to the policy	145	Annual review, approved Sept. 14, 2016
Modifier 50 – Bilateral Procedure	Added reimbursement percentage(s) to the policy	223	Annual review, approved Sept. 14, 2016
Modifier 52 – Reduced Services	Added reimbursement percentage(s) to the policy	224	Annual review, approved Sept. 14, 2016
Modifier 53 – Discontinued Procedure	Added reimbursement percentage(s) to the policy	236	Annual review, approved Sept. 14, 2016
Modifier 54/55/56 – Surgical Care Only/Post-operative Management Only/Pre-operative Management Only	Added reimbursement percentage(s) to the policy	184	Annual review, approved Sept. 14, 2016
Modifier 62 – Two Surgeons	Added reimbursement percentage(s) to the policy	009	Annual review, approved Sept. 14, 2016
Modifier 73 – Discontinued Ambulatory Surgery Center (ASC) Procedure Prior to Administration of Anesthesia	Added reimbursement percentage(s) to the policy	245	Annual review, approved Sept. 14, 2016
Modifier 78 – Unplanned Return to the Operating Room for a Related Procedure	Added reimbursement percentage(s) to the policy	240	Annual review, approved Sept. 14, 2016
Multiple Diagnostic Imaging Reduction	Annual review, no changes	381	Annual review, approved Sept. 14, 2016
Manipulation Services	Annual review, no changes	390	Annual review, approved Aug. 8, 2016
Medicare Indicator Status B Services Reimbursement	Annual review, no changes	366	Annual review, approved Aug. 8, 2016
Modifier 25 – Significant Separately Identifiable Evaluation and Management Service on Same Day of Procedure or other service	Annual review, no changes	101	Annual review, approved Aug. 8, 2016
Modifier 58 – Staged or Related Procedure or Service by Same Physician or Other Qualified Healthcare Professional during Post-operative Periods	Annual review, no changes	238	Annual review, approved Aug. 8, 2016
Modifier 91 – Repeat Clinical Diagnostic Laboratory Test	Annual review, no changes	218	Annual review, approved Aug. 8, 2016
Modifier JW – Drug Amount discarded/not administered to any patients	New policy, effective Aug. 31, 2016 Identifies guidelines on how to use modifier JW to represent drugs that are administered and those not administered due to being a single-use vial	400	New policy, approved July 27, 2016
National Drug Code (NDC) Billing Guidelines	New policy, effective Aug. 31, 2016 Policy identifies the correct steps for submitting an NDC drug code on a claim in both electronic and paper formats	404	New policy, approved July 27, 2016
Evaluation and Management (E&M) Visit Billed with Preventive Medicine Exam	Annual review, no changes	388	Annual review, approved Aug. 8, 2016
Screening Services with E&M Services	Annual review, no changes	391	Annual review, approved Aug. 8, 2016
Site Specifying Modifiers	Annual review, no changes	092	Annual review, approved Aug. 8, 2016
Telehealth/Telemedicine Services	Annual review, no changes	194	Annual review, approved Aug. 8, 2016
Acupuncture	Annual review, no changes	020	Annual review, approved June 26, 2016
After Hours Care	Annual review, no changes	137	Annual review, approved June 26, 2016
Global Surgery	Annual review, no changes	389	Annual review, approved June 26, 2016
Modifiers 80/81/82 – Assistant Surgeons (Physicians)	Added reimbursement percentages for each modifier	097	Annual review, approved June 26, 2016
Modifier AS – Physician Assistant, Nurse Practitioner or Clinical Nurse Specialist Services for Assistant at Surgery (Non-Physician)	Added reimbursement percentages for each modifier	374	Annual review, approved June 26, 2016
Multiple Cardiovascular Diagnostic Procedures Reductions	New policy, effective Oct. 17, 2016 Multiple procedure reductions on the technical components of applicable codes and an average percentage reduction on a global submission of an applicable code	401	New policy, approved June. 26, 2016
Multiple Ophthalmologic Diagnostic Procedures Reductions	New policy, effective Oct. 17, 2016 Multiple procedure reductions on the technical components of applicable codes and an average percentage reduction on a global submission of an applicable code	402	New policy, approved June. 26, 2016
Physical Therapy Services	Minor readability clarifications to sub-bullets	099	Annual review, approved June 26, 2016
Modifier RR – Durable Medical Equipment (RME) Rental	Annual review, no changes	397	Annual review, approved June 26, 2016