February 1, 2024
The following policies received their annual review with no changes:
The following policies received their annual review with the changes noted below:
Consultation Services
Revised the Policy statement to clarify that the policy already applied to Washington contracted providers and to Alaska contracted providers as of claim dates of service on and after December 11, 2023, as announced in the August 2023 policy version update.
Global Surgery
In the Policy section, added the following:
- In the section “Other Global Surgical Indicator Flag”, added the third bullet to the subsection “ZZZ-Related to another service”
- In the section “Services Included in Global Surgical Payment”, minor clarifications added to the first, fourth and ninth bullets
- In the section “Services Not Included in the Global Surgery Payment”, added the last bullet
- In the section on Modifiers 54, 55, and 56 section, added additional clarification to the second paragraph middle of the sentence
- In the Modifier 54 sub-section, added the third bullet
- In the Modifier 55 sub-section, added the second, third and fourth bullets
- In the Modifier 56 sub-section, added the second bullet
- IN the Modifier 57 section, minor clarification to the second sentence
- In the Modifier 76 section, in the last paragraph, added the last sentence referencing supporting documentation in the records for the modifier
- In the Modifier 77 section, in the second paragraph, added the first sentence
- In the Modifier 78 section, added the third paragraph referencing supporting documentation in the records for the modifier
- In the Modifier 79 section, added the fourth paragraph
Laboratory and Pathology Billing Guidelines
- In the section “Surgical Pathology”, at the end of the third paragraph, added a sentence on how to correctly bill for repeat lab tests with modifier 91
- In the section “Professional and Technical Lab Components”, added the PC/TC Indicator flag 5
- Added the new section ‘Lab Handling/Conveyance Fees”
Modifier SL – State Supplied Vaccine
- In the fourth paragraph, clarified that the vaccine administration codes 90460-90461 and 90471-90474 are not valid administration code for the SARS-CoV2 vaccine codes. Also corrected the range of terminated SARS-CoV2 codes to 91300-91317.
- In the “Codes/Coding Guidelines” section, added the last bullet for procedure code 90480 for the administration of the current SARS-CoV2 vaccines.