Payment Policy Updates March 2020

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

March 19, 2020

The following payment policies were annually reviewed with no changes:

• After-hours care
• Blood draw/venipuncture (36415)
• Facility fees: clinic services, professional fees, and specialty services – treatment room
• Home birth kit supplies
• New and established patient guidelines
• Prolonged services for labor management

The following payment policies were annually reviewed with changes:

• Modifier 79 – unrelated procedure/service by same provider during post-operative period
  Added a statement that modifier 79 should not be billed with E&M codes and that modifiers 58, 78 and 79 cannot be billed together on the same procedure code.
• Modifier 80/81/82 – assistant surgeons (physician)
  Noted in policy that if more than one or several physicians are needed on a complex procedure, such services should be billed as a “surgical team” using modifier 66 and not billed as assistants at surgery.
• Modifier AS – physician assistant, nurse practitioner or clinical nurse specialist services for assistant at surgery (non-physician)
  Noted in policy that if more than one or several physicians are needed on a complex procedure, such services should be billed as a “surgical team” using modifier 66 and not billed as assistants at surgery.
• Modifier SL – state-supplied vaccine
  Updated the link to the grid on the vaccine association’s website.
• Physical and occupational therapy services
  New codes 97129 and 97130, effective Jan. 1, 2020, were added to the policy and code 97127 was terminated as of Dec. 31, 2019 in the policy.

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