Here are the latest updates to our payment policies. You’ll need to log in to see the policy updates.
- Modifier 33 - Preventive Services
- Modifier 90 - Reference (Outside) Laboratory
Both policies annually reviewed; no changes to policy statement.
- Maternity Services
In the “Policy” section, updated the first paragraph in the “Global Obstetrical Package - 59400 59510 59610 59618” section to indicate that the date of delivery should be used as the date of service on the claim.
- Modifier 59 - Distinct Procedural Service
- In the “Cross Reference” section, added two payment policies that are referenced in the “Policy” section.
- In the “Policy” section, the following edits were made:
- Second paragraph, deleted the reference to non-Evaluation and Management since it was already stated in the sixth paragraph.
- Fourth paragraph, deleted the reference to the effective dates of Modifier XE, XS, XP and XU. Clarified the correct usage of these X-series modifiers.
- Sixth paragraph, added the full description for the E&M abbreviation.
- Seventh paragraph, clarified the wording of the paragraph to include a reference to the multiple diagnostic cardiovascular and multiple diagnostic ophthalmology payment policies.
- Modifier RA - Replacement of a DME, Orthotic, or Prosthetic item
Added the new policy for DME equipment in the “Cross Reference” section.
- Modifiers XE, XS, XP AND XU - Separate Encounter, Separate Structure, Separate Practitioner and Unusual Overlapping Service
- Added two new payment policies referenced in the policy statement in the “Cross Reference” section.
- In the “Policy” section, top of page 2:
- The first paragraph on this page is newly added, addressing the need for documentation on file.
- In the second paragraph, the deleted section became the new paragraph on page 2.
- The last paragraph in the “Policy” section on page 2 was revised to include reference to the multiple diagnostic cardiovascular and multiple diagnostic ophthalmology payment policies.