|
Payment policy
|
Updates
|
| Acupuncture |
- Added documentation for 50% practice expense portion reduction of lesser allowable PT or OT service
|
| Certified Nurse Midwives and Certified Professional Midwives |
- Annual review; no updates
|
| Chiropractic |
- Added documentation for 50% practice expense portion reduction of lesser allowable PT or OT service
|
| COVID-19 Public Health Emergency temporary payment policy |
- Updated COVID-19 vaccine and vaccine administration coding grid
|
| CPT and HCPCS Modifiers |
- Annual review; removed references to dates older than one year
- Addition of UN, UP, UQ, UR, US modifiers
- Annual coding update
- Added new modifiers AB, JZ, LU
- Updated revised modifiers JG and TB
- Removed payment in formation on JG modifier
- Updated modifier 59 code pairs
|
| Diabetic Care |
- Annual coding update
- Added new codes A4239 and E2103
- Removed deleted codes K0553, K0554
|
| Drug Wastage |
- Annual coding update
- Added new modifier JZ
|
| Durable Medical Equipment |
- Annual coding update
- Updated revised codes A9276, A9277, A9278
- Edited to clarify breast pumps section
|
| Emergency Room- Facility |
- Added crisis stabilization policy and billing guidelines
- Annual review; template update
- Updated EM definitions to align with 2023 AMA EM coding revisions
|
| Evaluation and Management |
- Annual coding update
- Revised hospital inpatient or observation code and consultation code descriptors and CPT 76882
- Revised initial hospital or observation reporting instructions and billing example
- Removed codes 99241, 99251, 99354-7
- Added CPT 99418 and HCPCS G0316-G0318 as not reimbursed
|
| Expanded Molecular Panel Testing of Cancers |
- Annual coding update
- Added new codes 81449, 81451, 81456
- Updated descriptions for 81445, 81450, 81455
|
| Frequency |
- Annual coding update
- Added code G0323
- Updated revised codes 99238, 99239, 00252-99254, 99304-99306, 99316, 99495, 99496, G0442, G0444
|
| General Coding and Billing |
- Annual review; removed references to dates older than one year
- Annual coding update
- Updated cat III range to 0783T
- Updated measurement codes M range to M1210
- Added modifier JZ
- Updated modifier 59 code pairs
|
| Home Infusion |
- Annual review; template update
- Added existing place of service and NDC billing guidelines
|
| Immunizations |
- Annual coding update
- Added code 90678
|
| Incident To Billing for Supervising Providers for Mental Health Services - Professional |
- Edited to clarify non-credentialed provider requirements
- Edited to clarify that the supervising provider needs to be immediately available when the non-credentialed provider provides care
- Edited to clarify that close collaboration with the supervising provider is highly recommended for new patient visits and psychiatric evaluations (99202-99205, 90791-90792)
|
| Mental Health and Substance Use |
- Added reimbursement and billing information on mental health services eligible for telehealth reimbursement effective for dates of service on or after November 1, 2022 for 99446-99449 and 99451-99452; acute care and mental health facilities must bill these services with a professional mental health revenue code 961
- Annual coding update
- Added new codes 96202, 96203, G0323
- Updated revised codes 99446-99451
- Removed deleted codes 99318, 99324-99337
- Added code ranges for home/residence and nursing facility
|
| Non-Reimbursable Services |
- Updated non-reimbursed list for professional providers link and non-reimbursable list for facility providers link
|
| Nurse Practitioner and Nurse Practitioner PCP |
- Annual review; updated related policies section
|
| Observation Services |
- Added crisis stabilization policy and billing guidelines
- Annual review; template update
- Updated information to align with 2023 AMA EM coding revisions
- Deleted codes 99217-99220, 99224-99226
|
| Physician Assistant and Physician Assistant PCP |
- Annual review; updated related policies section
|
| Radiology- Multiple Imaging |
- Annual coding review
- Added code 76883
|
| Surgery- Professional |
- Annual coding review
- Expanded skin graft Q code range
- Added existing policy statement for ASC reimbursement
|
| Telehealth (Telemedicine) - Medical Services |
- Revised reimbursement information for primary care providers and chronic condition diagnosis claims effective July 1, 2023
- Annual coding review
- Updated coding descriptions to match AMA coding descriptions
- Updated list of face-to-face medical services eligible to be performed via telehealth and/or telephone & reimbursable telephonic and telehealth services
- Added code G0323
|
| Telehealth (Telemedicine) – Mental Health |
- Added reimbursement and billing information on mental health services eligible for telehealth reimbursement effective for dates of service on or after November 1, 2022 for 99446-99449 and 99451-99452; acute care and mental health facilities must bill these services with a professional mental health revenue code 961
- Annual coding review
- Updated coding descriptions to match AMA coding descriptions
- Updated list of face-to-face medical services eligible to be performed via telehealth and/or telephone & reimbursable telephonic and telehealth services
- Added codes 99341-4, 99347-9, and G0323
|
| Transplant |
- Annual review; template update
- Edited to clarify donor billing instructions
|
| Urgent Care Center |
- Annual coding update
- Added new codes 99418, G0316 to G0318
- Removed end dated codes 99354-99357
- Updated codes 99417, 99446-99449, 99451, G2212
|
| Vision Services |
- Annual coding update
- Revised description for 92065
- Added code 92066
|
