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Updated payment policies now available
December 30, 2022

This article is for all providers caring for our members

The following payment policies, updated in Q4 2022, are now available on Provider Central.

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

Click here to download our payment policies.

To download our payment policies, log in and click Find a Payment Policy on the right side of your home page. Or, go to Office Resources>Policies & Guidelines>Payment Policies.

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