Here are the latest updates to our payment policies. You’ll need to log in to see the policy updates.
- Policy 406 – Preadmission Testing (New)
- Policy becomes effective with dates of service on or after January 1, 2018.
- The policy indicates that related outpatient facility diagnostic and non-diagnostic services (pre-admission testing) provided by an admitting hospital on the date of an inpatient admission or within 3 calendar days preceding the date of an inpatient admission are considered part of/incidental to the inpatient admission hospital claim and not separately billable or reimbursable.
- For details on how to bill these services and learn of some exclusions, review the posted payment policy.
- Policy 405 – National Drug Code (NDC) Billing Guidelines – Outpatient Facility Claims (New)
- Policy 404 – National Drug Code (NDC) Billing Guidelines – Professional Claims
- Effective with dates of service on or after January 1, 2018, a National Drug Code (NDC) number is required to be submitted for drugs, vaccines, or radiopharmaceuticals administered or supplied in an outpatient setting (office, home, outpatient facility, etc.) along with an appropriate CPT or HCPCS code for the drug, vaccine, or radiopharmaceutical administered.
- Claims submitted for drugs/radiopharmaceuticals without an NDC number will be rejected during the electronic data interchange (EDI) process.
- Details on how and where to add an NDC number on either a professional claim (CMS-1500 paper or ANSI 837P electronic) or a facility claims (UB-04 paper or ANSI 837I electronic) can be found in each of the above payment policies.