Payment Policy Updates January 2018

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

1. Modifier 66 – Surgical Team
2. Modifier SG – Ambulatory Surgery Center (ASC) Facility Service
3. Modifier SU – Procedure Performed in Physician’s Office (Facility and Equipment)
4. Multiple Endoscopy Procedure Reductions
5. Multiple Modifiers
6. Multiple Surgical Reductions Annual review; no changes made
7. Modifier 73 – Discontinued ASC Procedure Prior to Administration of Anesthesia
8. Modifier 74 – Discontinued ASC Procedure After Administration of Anesthesia Cross-referenced each policy to the other modifier policy. Clarified that modifier 53 is only used on Professional claims, not on ASC claims. Clarified that each modifier are only appropriate for submission by an ASC
9. Modifier 76 – Repeat Procedure by the Same Provider
10. Modifier 77 – Repeat Procedure by Another Provider
    Clarified that the “repeat procedure” was subsequent to the initial procedure
11. Telehealth/Telemedicine Services
    • Indicated that telehealth/telemedicine services must use a secure, encrypted HIPAA-compliant teleconferencing systems
    • In the Synchronous/Asynchronous Communications Section, indicated that a member may initiate a telehealth/telemedicine visit using a provider’s encrypted HIPAA compliant system and that in the case of asynchronous communications, the patient is not present
    • Created new section header, Telehealth Modifiers, to call out these modifiers separately
    • In the Telephone Assessment and Management section, added bullets at the end of this section for additional examples of what the telephone assessment does not cover

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