Payment Policy Updates

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

    January 1, 2020

    Allergen Immunotherapy Unit Limits
    Clarified that the maximum yearly dose frequency for allergen immunotherapy is based on a rolling 12-month period which includes all provider code submissions.

    Consultation Code Services
    Annual review; no changes.

    Contract Exclusions/Disallowed Charges-IP and OP Facility Services
    Removed a statement in the “Pharmacy Charges” section of the policy which conflicted with the “Nursing Care” section.

    Drugs Administered in a Physician Office
    Annual Review; no changes.

    Maternity Services

    • Throughout the policy, removed the footnotes and clarified the single submission of maternity codes statement
    • In the “Global Obstetrical Package” section: revised the wording on a number of bullets and added new bullets for services included in the “Global OB Package”
    • In the “Delivery Only” section: Revised the wording on a number of bullet point and added additional services included in the “Delivery Only” service
    • In the “Delivery including Postpartum Care” section: Expanded and clarified the description paragraph of what is included in this service
    • In the “Postpartum Care” section, clarified the description of this category
    • In the “Unlisted Maternity Care and Delivery” section: Removed the 2016 effective date for this criterion on the unlisted code
    • In the E&M Section: Revised the wording of this section and moved the Alaska exception to the exceptions section

    Medicare Status B Codes
    Annual Review; no changes.

    Modifier 51
    Annual Review; no changes.

    Multiple Diagnostic Ophthalmology Services Reduction
    Annual Review; no changes.

    Telehealth/Telemedicine Services

    • In the definitions section: Expanded and clarified the “Originating Site” definition.
    • In the “Modifier” section: Revised the layout of the list of modifiers.
    • Added new section “Originating and Distant Site” description to clarify the difference of the two sites.
    • Added new section “Documentation and Storage of Telehealth/Telemedicine Encounters” to indicate that permanent storage must occur for any telehealth service and available for review upon request.
    • In the “Codes/Coding Guidelines” section: added a summary of the CPT Coding guidelines for using the codes noted in the “Asynchronous codes”, “Telephone Assessment and Management codes” and the “Online Digital E&M Services” sections;
    • Indicated that the codes in the “Online Digital E&M Services” section will terminate as of the new year and identified the new replacement codes.
    • In the “exceptions” section: The listed exceptions would no longer be valid or implemented as of claims processed on and after April 5, 2020; 90-day notice to providers will be in the January 2, 2020 Provider News.
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