Payment Policy Updates

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    November 19, 2020

    Summary of Policy Updates:

    Acupuncture

    Clarified the purpose statement to indicate the policy refers to professional services billed on a CMS-1500 or 837P claim form; clarified that one unit is associated with each acupuncture code billed.

    Consultation Code Services

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

    Removed references to interprofessional telephone/internet consultation codes. The codes became reimbursable as of January 1, 2019, and are covered in the telehealth services policy.

    Removed the cross reference to Medicare Status B codes. The interprofessional telephone/internet consultation codes are no longer classified as Status B codes.

    Contract Exclusions/Disallowed Changes – Inpatient and Outpatient Facility Services

    Clarified the purpose statement to indicate the policy refers to facility services billed on a CMS-1450/UB-04 paper claim or 837I electronic claim form.

    In the “Nursing Services” section, clarified the last bullet regarding “venipuncture” charges.

    In the “Operating Room/Surgical Suite” section, clarified that the professional and technical services are those for “facility employed” personnel.

    Manipulation Services

    Clarified the purpose statement to indicate the policy refers to professional services billed on a CMS-1500 or 837P claim form. Clarified billable units for each code billed in the chiropractic and osteopathic sections.

    Modifier 26-Professional Component

    Clarified the purpose statement to indicate the policy refers to professional services billed on a CMS-1500 or 837P claim form; inserted PC/TC indicator flags 1 and 6 into the codes/coding guideline section.

    Modifier SU-Procedure Performed in Physician’s Office (Facility and Equipment)

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

    Modifier TC-Technical Component

    Clarified in the purpose statement that the policy applies to professional services billed on a CMS-1500 or 837P claim form. Inserted PC/TC indicator flags 1 into the codes/coding guideline section.

    Multiple Endoscopy Procedure Reductions

    Clarified in the purpose statement that the policy applies to professional services billed on a CMS-1500 or 837P claim form. Added in the exception section that the policy doesn’t apply to any provider reimbursed under the Ambulatory Surgery Center-Ambulatory Payment Classification (ASC-APC) payment methodology

    Multiple Modifiers

    Clarified in the purpose statement that the policy applies to professional services billed on a CMS-1500 or 837P claim form. Added exception that the policy doesn’t apply to providers reimbursed using Ambulatory Surgery Center-Ambulatory Payment Classification (ASC-APC) payment methodology.

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