Here are the latest updates to our payment policies. You’ll need to log in to see the policy updates.
June 21, 2018
Modifier 90 – Reference (Outside) Laboratory
As announced in the March 15, 2018 Provider News, this policy is expanded to include all providers effective with claims processed on and after August 12, 2018. Modifier 90 will no longer be reimbursed. Laboratory services must be submitted to the Plan by the Provider who actually performed the laboratory test/analysis.
June 7, 2018
Add-On Codes – (New policy effective 06/15/2018)
This policy supports a new claims edit that was announced earlier in the March 15, 2018 Provider News. The policy indicates that add-on codes will be denied reimbursement if they are billed by themselves without an appropriate primary/parent procedure code.
Add-on codes must be billed in addition to another primary code as they represent additional services rendered in conjunction with the primary procedure. These codes are identified in the CPT codebook by the plus ( + ) symbol and also listed in a separate appendix at the end of the same codebook. In the HCPCS codebook, these codes are usually found at the end of a code category and include phrasing such as “list separately in addition to primary procedure.”