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Updated payment policies now available
June 30, 2022

This article is for all providers caring for our members

The following payment policies, updated in Q2 2022, are now available on Provider Central:

Payment policy Updates
Acupuncture
  • Annual review; no changes

Anesthesia

  • Annual review
  • Included information regarding non-reimbursed surgical codes reported for general anesthesia
  • Added reimbursement information for G0500
  • Reorganized CRNA billing information
Applied Behavior Analysis (Autism)
  • Annual review
  • Changed policy title from Autism to Applied Behavior Analysis
  • Edited for clarity
  • Added reference to medical policy 144: Applied Behavior Analysis Service Request Form for Initial Assessment and Treatment
  • Edited to clarify Blue Cross reimburses and Blue Cross does not reimburse sections
  • Updated 97151 to allow up to 48 units every six months (180 days)
  • Edited to clarify coding grid

Assisted Reproductive Technology

  • Updated fee for vial of sperm
  • Added specific NPI billing instructions
  • Updated storage information for embryos, sperm, and oocytes

Bilateral Services

  • Annual review
  • Edited to clarify coding edit for bilateral radiology procedures
Cardiology Services
  • Annual review
Community Mental Health Centers
  • Annual review; no changes
Evaluation and Management
  • Annual review
  • Edited to clarify new patient definition when provider changes practice
  • Added FS modifier place of service information
  • Added services included in transitional care
  • Included complex chronic care services as reimbursed
  • Removed 99421-3, 99446-9, and 99451-2 from coding grid
Gastroenterology
  • Added coding guidelines for follow up colonoscopy
Immunizations
  • Annual review
  • Edited to clarify diagnosis codes Z28.20 – Z28.9
  • Updated information for CPT 90750
Incident To Billing for Supervising Providers for Mental Health Services – Professional
  • Documentation of payment policy effective 8/1/22
  • Updated general reimbursement information section to remove the requirement for a supervising provider to personally treat, establish the diagnosis, and develop the plan of care for the patient on the first visit or for any new condition/diagnoses
Newborn and Neonatal Intensive Care Services
  • Annual review
  • Edited to clarify that a new claim is required for each newborn charge
  • Added CPT_HCPCS payment policy under “Related policies” section
Non-Reimbursable Services
  • Updated links to non-reimbursable list for professional providers and non-reimbursable list for facility providers
Obstetrical and Maternity Care
  • Annual review
  • Added Certified Nurse Midwives payment policy under “Related policies” section
Oncology
  • Annual review
  • Added information regarding Z5111 and Z5112 edits for coding clarity
Orthopedic
  • Annual review
  • Edited to clarify non-reimbursed robotic surgical services
Physician Assistant and Physician Assistant PCP
  • Updated to include psychiatric PA’s may provide behavioral health services
PT/OT- Independent Practice
  • Annual review
  • Added modifiers CO and CQ to coding grid
Telehealth (Telemedicine) – Medical Services
  • Removed the following statement- Medicare Advantage Product: Services provided via telephone/audio only may not be reimbursed beyond publish health emergency (PHE)
  • Revised title of “Documentation Requirements for Telehealth” section to “Regulatory Requirements for Telehealth”
Telehealth (Telemedicine) – Mental Health
  • Removed the following statement- Medicare Advantage Product: Services provided via telephone/audio only may not be reimbursed beyond publish health emergency (PHE)
  • Revised title of “Documentation Requirements for Telehealth” section to “Regulatory Requirements for Telehealth”
  • Edited to clarify information in “Face-to-face mental health services delivered via telehealth or telephone” section
Urgent Care Center
  • Annual review; no changes
Vision Services
  • Added CPT 67031 and 66821 to coding grid
  • Included information for Medicare Advantage non-routine claim submission

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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