Payment Policy Updates

  • May policy updates

    The following policies received their annual review with no changes:

    The following policies received their annual review with the changes noted below:

    • Modifier 24 – Unrelated evaluation and management service by the same physician in the post-operative period
      • Clarified that the same physician or other qualified healthcare professional is based on the provider's national provider identifier (NPI).  Additional examples of when not to use modifier 24 added to the fourth paragraph.
    • Modifier 47 – Anesthesia by surgeon
      • Clarified in the first paragraph that modifier 47 is appended to a surgical service code.
    • Modifier 50 – Bilateral procedure
      • Added a paragraph that for the site-specific anatomic locations of the eyelids, fingers and toes, the site specifying modifiers should be appended rather than Modifier 50. Added paragraph to indicate that NPFS flag 9 services may use other resources if modifier 50 is applicable.
    • Modifier 62 – Two surgeons
      • Added clarification that surgical procedures with flag 9 may utilize other professional resources to make exceptions.
    • COVID-19 Testing
      • Revised the policy title. Removed the diagnosis codes under the surveillance testing section due to configuration in claims processing system. Added the new over-the-counter (OTC) COVID-19 test code k1034 to the OTC section of the policy and in the codes/coding guidelines section.
    • Telehealth/Telemedicine Services
      • In the telephone assessment (audio only) section, two paragraphs added, applicable to Washington state providers only, that describe requirements for an established relationship with the audio-only patient that will need to be present effective January 1, 2023.
      • In the originating and distant site section, a list of originating sites has been added, applicable to Washington state providers only, effective June 8, 2022. In addition, a paragraph was added to the end of this section, exclusive to Washington state providers only, that an originating site fee (Q3014) cannot be billed for any audio-only services.
      • In the telehealth modifiers section under audio-only services, additional information on the use of Modifier 93 was added.
      • In the code/coding guidelines section, removed terminated codes G2061, G2062 and G2063.
      • In the laws, regulations, and standards section, added the recently passed Washington state house bills affecting audio-only services.
    • Manipulation services
      • In the cross-reference section, added two policies referenced in the policy section:  modifier 59 and modifiers XE, XS, XP, and XU. In the policy section, expanded the sections for chiropractic and osteopathic manipulations to provide more clarification on coding of each type of service.
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