Payment Policy Updates

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

    February 4, 2021

    Anesthesia Guidelines
    Clarified the purpose statement to indicate the policy applies to professional services billed on a CMS-1500 or 837P claim form. Minor modifications were made to the modifiers section of the policy statement. A list of anesthesia modifiers was added to the Codes/Coding Guidelines section which are appended to identify the level of provider rendering the anesthesia service.

    Anesthesia Modifiers
    Clarified purpose statement to indicate the policy pertains to professional services billed on a CMS-1500 or 837P claim form.

    Drug Assay Services/Urine Drug Testing
    Clarified the purpose statement to indicate the policy pertains to professional services billed on a CMS-1500 or 837P claim form. In the presumptive procedures section of the policy, code 0020U was deleted and new code 0227U was added effective January 1, 2021. A full description for code 0227U was added to the Codes/Coding Guideline section.

    Global Surgery
    Clarified the purpose statement to indicate the policy pertains to professional services billed on a CMS-1500 or 837P claim form. A link was added to the National Physician Fee Schedule in the policy statement.

    Modifier 33 – Preventive Services
    Clarified the purpose statement to indicate the policy pertains to professional services billed on a CMS-1500 or 837P claim form.

    Modifier 59-Distinct Procedural Services
    Clarified the purpose statement to indicate the policy pertains to professional services billed on a CMS-1500 or 837P claim form.

    Modifier KX – Requirements Specified In The Medical Policy Have Been Met
    Clarified the purpose statement to indicate the policy pertains to professional services billed on a CMS-1500 or 837P claim form. A reference was deleted to the medical policy because the policy has been archived.

    Modifier NU – New DME Equipment and Modifier NR – New DME Equipment When Rented
    Clarified the purpose statement to indicate the policy pertains to professional services billed on a CMS-1500 or 837P claim form.

    Modifier RA – Replacement of a DME, Orthotic or Prosthetic Item
    Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P claim form.

    Modifier RR – Durable Medical Equipment (DME) Rental, Modifier KR-Rental Item-Partial Month And Modifier LL-lease/rental
    Clarified the purpose statement to indicate the policy pertains to professional services billed on a CMS-1500 or 837P claim form.

    Modifiers XE, XS, XP AND XU – Separate Encounter, Separate Structure, Separate Practitioner And Unusual Overlapping Service
    Clarified the purpose statement to indicate the policy pertains to professional services billed on a CMS-1500 or 837P claim form. The modifier descriptions were moved from the policy statement to the new section codes/coding guidelines.

    Preadmission Testing
    This policy applies to DRG reimbursed hospitals only. Clarified the purpose statement to indicate the policy applies to facility services billed on a UB-04/CMS-1450 paper claim form or 837I electronic claim form. Clarification was added to the “related services” that would not be separately reimbursed for those services billed on an outpatient facility claim. Resources were also added that were used to create the policy.

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