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Updated payment policies now available
March 31, 2022

This article is for all providers caring for our members

The following payment policies, updated in Q1 2022, are now available on Provider Central:

Payment policy Updates
Allergy Services
  • Annual review
  • Updated related policies section
Assisted Reproductive Technology
  • Annual review
  • Added CPT & HCPCS Modifiers policy as reference
Chiropractic
  • Annual review; no updates
COVID-19 Public Health Emergency temporary payment policy
  • Added vaccine and vaccine administration codes: 0073A, 91305, 0051A, 0052A, 0053A, 0054A
  • Added monoclonal antibody codes: Q0220, M0220, and M0221
  • Clarified that the telehealth reimbursement section is effective until 3/31/22, and that effective 4/1/22 the telehealth guidelines within this document will be replaced by the following updated payment policies: Telehealth – Mental Health and Telehealth – Medical Services
Diabetic Care
  • Annual review
  • Inclusion of A4224 information
  • Updated information on A9274
  • Removed billing guidelines for V-Go insulin delivery system
  • Updated title for certified diabetes educator
Durable Medical Equipment
  • Annual review
  • Updated breast pump and supply information
  • Addition of ostomy supplies information
Gastroenterology
  • Annual review
  • Removed reference to effective date
  • Updated information regarding E/M reimbursement with 0, 10, or 90-day global procedures
Non-Reimbursable Services
  • Updated non-reimbursable list for professional providers link and non-reimbursable list for facility providers link
  • M1072-M1089 and M1094-M1105 code ranges were removed from professional and facility non-reimbursable list
  • Added Q0220, Q0221, and Q0222 to non-reimbursable list and end-dated G1009 and M1145
Podiatry
  • Annual review; no updates
Radiology
  • Annual review
Radiology- Multiple Imaging
  • Annual review
  • Edits for reimbursement clarity
Respiratory DME
  • Annual review
  • Edited to clarify for TW modifier
Surgery – Professional
  • Annual review
  • Added reimbursement information regarding surgeries within the global period of another surgery
  • Addition of teaching physician criteria
Telehealth – Medical Services
  • Edited for clarity in the Reimbursement section
  • Edited for clarity in the Professional Non-Facility (office) Reimbursement versus  Professional Facility Reimbursement section
  • Addition of place of service billing scenarios
  • Removal of examples of HIPAA-compliant technology
  • Edited for clarity on provider licensing requirements
  • Edited for clarity on Medicare Advantage statement
  • Added link to CMS list of chronic condition categories
Telehealth – Mental Health
  • Edited for clarity in the Reimbursement section
  • Edited for clarity in the Professional Non-Facility (office) Reimbursement versus    Professional Facility Reimbursement section
  • Addition of place of service billing scenarios
  • Removal of examples of HIPAA-compliant technology
  • Edited for clarity on provider licensing requirements
  • Edited for clarity on Medicare Advantage statement
  • Updated list of face-to-face mental health services eligible to be performed via telehealth and/or telephone
  • Updated list of reimbursable telephonic and telehealth services to include: H0025, H0046, 99439, G1028, 99424, 99425, 99426, 99427, and 99437

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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