Here are the latest updates to our payment policies. You’ll need to log in to see the policy updates.
June 2021 Payment Policy Updates
Hospital Or Hospital System Readmissions
The readmission definition has been revised and reduced from 14 days to 5 days of a prior acute care inpatient hospital or hospital
system discharge. New definitions were created for Same Condition, Readmission Period and Unplanned Readmission. The policy section is now revised to reflect a 5-day readmission period and how the two inpatient claims are reimbursed. The implementation
date of these changes will be claim process dates on and after September 3, 2021 (90-day advance notice).
New Policy- Laboratory And Pathology Billing Guidelines
This policy defines correct ways to code various lab issues such as but not limited to lab panels (both lab panel codes
and proprietary lab panels), multiple surgical pathology specimens, professional/technical lab billing, dates of service and billing all lab tests analyzed on the same claim. The implementation date of this new policy will be claim process dates on and after July 5, 2021 (30-day correct coding notice).
Medicare Indicator "Status B" Services Reimbursement
In response to Washington Senate Bill 5169-2021, this policy is revised to allow code 99072 to be a payable code effective
with dates of service April 16, 2021, for the duration of the federally declared public health emergency. Code 99072 is payable to Washington state providers only, all other provider submissions of this code will continue to be denied
per policy criteria.
Personal Protective Equipment (PPE)
In response to Washington Senate Bill 5169-2021, this policy is revised to allow code 99072 to be a payable code effective with dates of
service April 16, 2021 for the duration of the federally declared public health emergency. Code 99072 is payable to Washington state providers only, all other provider submissions of this code will continue to be denied per policy
criteria.
Unlisted, Non-Specific, And Miscellaneous Procedure Codes
Within the policy statement, the section Supporting Documentation Requirements was revised. Documentation requirements
in the table of codes are now expanded to be more specific regarding the type of supporting documentation required for submission when billing an unlisted code for payment. The implementation date of this expanded documentation criteria will be claim process dates on and after July 5, 2021 (30-day correct coding notice.