The following Payment Policy has been withdrawn: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.
Contract Exclusions/Disallowed Charges-Inpatient Facility Services
Effective 3/01/2020, the following additional services and service categories will be not separately reimbursable:
Modifier 57 - Decision for SurgeryAdded a definition of “pre-operative period” in the second paragraph of the policy statement
Modifier 63 - Procedure performed on Infants less than 4kgAdded additional qualifiers in the policy section as to appropriate use of modifier 63, paragraphs 3 and 5
Modifier 66 – Surgical TeamClarified in the second paragraph documentation requirements for each surgeon’s participation in the surgery
Modifier 73 – Discontinued ASC Procedure Prior to Administration of Anesthesia
Modifier 74 – Discontinued ASC Procedure after Administration of Anesthesia
Modifier 76 – Repeat Procedure by the Same ProviderAdded the second and third paragraphs in the Policy section to clarify the documentation requirements to support the need for the repeat procedure and to identify scenarios of inappropriate usage of modifier 76
Modifier 77 – Repeat Procedure by another ProviderAdded the second paragraph to indicate that the reason for a repeat procedure should be documented
Modifier TH – Obstetrical treatment/services
Multiple Deliveries/BirthsIn the examples discussing the second and subsequent deliveries, added a recommendation of the modifier to use when submitting these additional deliveries
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