Provider Central

Payment policy

Updates

COVID-19 temporary payment policy

• Removed deleted codes effective December 13, 2023: M0245, Q0245
• Removed deleted codes effective December 12, 2024: M0221-M0222, Q0220, Q0240, Q0243-Q0244
• Removed deleted code effective April 1, 2025: M0243

CPT and HCPCS Modifiers

• Updated Medicare Advantage facility modifier 59 code pairs link
• Removed delay statement from modifier FT

Diabetic Care

• Annual review; template update
• Added Medicare Advantage reimbursement information for A9276
• Added modifier 76 billing information to G9886 and G9887

Dialysis

• Annual review; template update
• Added Medicare Advantage billing and reimbursement guidelines effective January 1, 2025 for CPT 99070 and revenue code 0270 when billed by a freestanding dialysis provider

Durable Medical Equipment

• Annual review; template update
• Added link to newly created K0108 appeals fact sheet
• Removed language for prior authorization for negative pressure closure therapy
• Removed duplicative Wound Vac entry (medical policy 543) from reimbursement table
• Added how to bill a repair to a covered device using codes K0739, K0462, and E1399 with RB modifier

Evaluation and Management

• Added additional venipuncture codes to deny when billed with E/M or lab services: 36405, 36406, 36410, 36420, 36591, and 36592

Expanded Molecular Panel Testing of Cancers

• Added new codes effective April 1, 2025: 0538U, 0539U, 0543U

Family Planning

• Annual review; template update

General Coding and Billing

• Updated Medicare Advantage facility modifier 59, XE, XP, XS, XU code pairs link

Laboratory and Pathology

• Added additional venipuncture codes to deny when billed with E/M or lab services: 36405, 36406, 36410, 36420, 36591, and 36592

Mental Health and Substance Use

• Annual review; template update
• Added billing information for psychotherapy codes

Non-Reimbursable Services

• Updated non-reimbursed list links for both professional providers and facility providers
• Removed deleted remark for codes G9919 and G9920
• Edited to clarify state-supplied ages less than or equal to 18 for code 90611

Radiology

• Template update
• Edited to clarify “Blue Cross reimburses” and “General reimbursement information” sections

Radiology – Multiple Imaging

• Annual review; template update

Respiratory Durable Medical Equipment (DME) Services

• Annual review; template update
• Added E0468 to coding grid
• Added E0446 and E0447 oxygen contents codes
• Added K0462 billing information