August 3, 2023
The following policies received their annual review with no updates/changes:
The following policies received their annual review with the updates/changes noted below:
Abortions-Facility Services
In the policy section, under the Outpatient Facility Claims Only subsection, added Healthcare Common Procedure Coding System (HCPCS) abortion procedure codes for induced abortions.
Abortions-Professional Services
In the policy section, added HCPCS abortion procedure codes for induced abortions.
Acupuncture
In the policy section, added clarification in the second paragraph that two units of time represent two 15-minute increments of time; and in the final paragraph, clarified the acupuncture needles are considered inclusive of the acupuncture service and not separately reimbursable.
Contract Exclusions/Disallowed Charges – Inpatient and Outpatient Facility Services
Added and/or modified the following sections to provide for clarification on non-reimbursable services:
- Nursing:
- PICC line insertion
- Incremental therapy charges
- Ventilator adjustments performed by a registered nurse (RN)
- Equipment considered part of special level of care room:
- Oxygen per day/per hour charges
- Ultrasound guidance for procedures
- Equipment considered part of a service or procedure:
- Feeding pumps
- Flow meters
- Glucometers
- IV tubing and sets
- PCA pump/pain pump
- Perfusion equipment and supplies in the operating room
- Procedure specific tool kits/instruments rented, loaned or purchased
- Operating Room Surgical Suite:
- Special/custom surgical tools
- Respiratory:
- CPAP/O2 when patient is on ventilator support
- Nursing/respiratory care performed while patient is on a ventilator
- Weaning/extubating of patient off a ventilator
- Point-of-care testing
- Laboratory:
- Blood draws from capillary puncture, arterial or venous devices
- Point-of-care testing
- Emergency Room:
- IV starts, IV administration, IV push, IV flush and assessments, dressing changes and infusion of fluids
Modifier TC – Technical Component
In the codes/coding guidelines section, added flag 6-Laboratory Physician Interpretation Codes
Multiple Modifiers
In the policy section, added the last paragraph indicating how to code when more than 4 modifiers are applicable for the procedure code submitted
Place of Service Codes
Added exception in response to Washington legislation HB1196 which describes how Washington in-network providers are to be reimbursed for POS code 02 and 10 for telehealth audio only services.