October Payment Policy Updates

The following payment policies received annual review with no changes to policy content:

Consultation Code Services

Contract Exclusions/Disallowed Charges –Inpatient and Outpatient Facility Services

Modifier 26 – Professional Component

Modifier SU – Procedure Performed in Physician's Office

Modifier TC – Technical Component

Multiple Endoscopy Procedure Reductions

Multiple Modifiers

The following payment policies received their annual review with the changes noted below:

Acupuncture

In the policy section, clarified the guidelines for billing an evaluation and management (E&M) service on the same date as an acupuncture service. Also added the last paragraph clarifying coding guidelines for coding acupuncture codes along with needle insertion codes. In the codes/coding guidelines, added codes and code descriptions for 20560 and 20561.

Manipulation Services

In the policy section, clarified the guidelines for billing an evaluation and management (E&M)  service on the same date as a chiropractic or osteopathic manipulation.

Telehealth/Telemedicine Services

In the telephone/audio only section, added a paragraph indicating that member consent for an audio-only encounter needs to be obtained prior the encounter. Clarified the definitions of the originating and distant site providers. Removed codes from the codes/coding guidelines section that are no longer active codes. Added a new definition for "audio-only telemedicine" in the definitions section.

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