May 3, 2018
Here are the latest updates to our payment policies. You’ll need to log in to see the policy updates.
- Acupuncture – Created new section Codes/Coding Guidelines and inserted the codes and descriptions that are discussed in the Policy section
- After Hours Services – Created new section Codes/Coding Guidelines and inserted the codes and descriptions that are discussed in the Policy section; removed the code descriptions from the Policy section
- Modifiers 80/81/82 – Moved the table discussing the modifiers into the new section Codes/Coding Guidelines
- Modifier AS – Moved the table discussing the modifiers into the new section Codes/Coding Guidelines
- Multiple Diagnostic Ophthalmology Reductions – Annual review, no changes
- Robotic Surgery – Created new section Codes/Coding Guidelines and inserted the codes and descriptions that are discussed in the Policy section; removed the code descriptions from the Policy section
- Unlisted, Non-Specific Misc. procedure codes – Clarified the first paragraph in the segment Clinical Review of All unlisted Non-Specific and Misc. Codes. Added an additional statement in the second to last paragraph in the Policy statement indicating that the documentation must specifically call out the service being billed using the unlisted code.
May 17, 2018
- Evaluation and Management (E&M) Visit Billed with Preventive Medicine Examination – Clarified requirements in the first and last section of the Policy section; created new section Codes/Coding Guidelines and listed out all of the involved codes
- Manipulation Services – Created new section Codes/Coding Guidelines and moved all codes from the Policy section into the new codes section
- Medicare Indicator Status B Services Reimbursement – Annual review; no changes made
- Modifier 25 – Significant, Separately Identifiable Evaluation and Management (E&M) Service on Same Day of Procedure or Other Service – Clarified requirements in the first and last paragraph in the Policy section
- Modifier 58 – Staged or Related Procedure or Service by Same Physician or other Qualified Healthcare Professional During Postoperative Period – Annual review, no changes
- Modifier 91 – Repeat Clinical Diagnostic Laboratory Test – Added further clarification to requirements in the Policy section
- Modifier JW – Drug Amount Discarded/Not Administered to any Patient – Added an additional policy reference in the Cross Reference section; clarified requirements in the Policy section
- Screening Services with Evaluation and Management (E&M) Services – Created new section Codes/Coding Guidelines and moved all codes from the Policy section into the new codes section; added clarification on the criteria for each code classification
- Site Specifying Modifiers – Expanded on the appropriate use of modifiers LT, RT and 50 in the Policy section