Payment Policy Updates April 2020

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

April 2, 2020

Annual review completed for the following March payment policies:

• Evaluation and Management (E&M) Visit billed with a Preventive Medicine Exam
  Added in the cross-reference section for the policy “Screening Services with Evaluation and Management Services”
• Hospital or Hospital System Readmissions
  Annual review; no changes made
• Modifier 25
  Added in the cross-reference section for the policy “Screening Services with Evaluation and Management Services” since this modifier is referenced in the added policy
• Modifier 58
  Annual review; no changes made
• Modifier 91
  Added in the cross-reference section the policy “Modifier 76-Repeat Procedure by the same Provider” since this modifier is referenced in the added policy
• Physical and Occupational Therapy Services
  Moved the new codes 97129 and 97130 into the “Therapeutic Procedures” sub-bullet in the policy statement
• Robotic Surgical System and Computer-Assisted Navigation Codes
  Added paragraph to indicate the edit is expanded to include facility claim charges effective with claim process date of July 15, 2020 and after
• Screening Services with Evaluation and Management Services
  Added in the cross-reference section the policy “Evaluation and Management (E&M) Visit Billed with a Preventive Medicine Exam”
• Site Specifying Modifiers
  Annual review; no changes made
• Telehealth/Telemedicine Services
  Removed the reference to “telephone calls” in the asynchronous communications sub-section since this is now covered as part of the “interprofessional communications” codes

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