Payment Policy Updates

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

    May 7, 2020

    The following policies received their annual review with no changes:

    The following policies received their annual review and have some revisions:

    • Modifier 62-Two Surgeons
      Clarified how co-surgeons billing the same procedure code should submit their claims with Modifier 62 when they both act as co-surgeons on the same surgical procedure. A new edit to enforce this criterion will be implemented with claims processed on and after August 6, 2020.
    • Modifier 90-Reference/Outside Laboratory
      Modified the “Exceptions” section to be more reflective of provider contract language.
    • Serious Adverse Events
      Removed the reference to “External Cause Codes” since that paragraph referred to the external cause codes in ICD-9-CM.
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