Here are the latest updates to our payment policies. You’ll need to log in to see the policy updates.
December 3, 2020
Summary of Policy Updates:
Allergen Immunotherapy (95165) Unit Limits
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 paper or 837P electronic claim form. Made a minor clarification of wording in the third paragraph of the policy section.
Drugs Administered in Physician Office
A facility payment policy that was referenced in the cross reference section was removed. Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 paper or 837P electronic claim form.
Maternity Services
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 paper or 837P electronic claim form. Additional services were added in the global OB package and delivery only sections. Added the pregnancy confirmation codes and descriptions in the codes/coding guidelines section.
Medicare Indicator “Status B” Services Reimbursement
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a cms-1500 or 837p claim form. In the policy section, identified where the Status B indicators come from, located and clarified to pull the file version appropriate for the date of service billed. Minor revisions made to the code exception section to make it easier to read.
Modifier 51 – Multiple Procedures
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P claim forms. A link to the National Physician Fee Schedule Relative Value file was added. Clarified the location of Appendix E of Modifier 51 exempt procedure codes as being in the CPT codebook.
Modifier 90 – Reference (Outside) Laboratory
Expansion of the policy to facility claims effective with dates of service January 13, 2021 and after is being rescinded and will not be implemented.
Multiple Diagnostic Ophthalmology Services Reduction
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P claim form. A link to the National Physician Fee Schedule Relative Value file was added. Added a bullet to the exceptions section indicating the policy does not apply to ASCs paid on APC payment methodology.
Telehealth/Telemedicine Services
Clarified the purpose statement to indicate that the policy applies to Professional Claims. The definitions were moved after the code/coding guidelines section. In the introductory paragraphs of the policy section, identified the methods of electronic communications the policy applied to audio and video, telephone, and online digital exchanges. In the documentation subsection, expanded the criteria for documenting a “telehealth” encounter via a telecommunications system. In the codes/coding guidelines section, the following new sections were added:
- A new section, telemedicine real-time communication (audio and video required), and provided examples of acceptable coding
- HCPCS codes applicable for qualified non-physician providers usage in the online digital services (secure emails, MyChart, text messages, etc.)
In the exception section, it’s indicated that telephone assessment codes and the online digital services codes can be billed for new patient visits even though the code description itself indicates “established patients.”