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- As of Jan. 1, 2017, policy criteria no longer valid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
|