Payment policy
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Updates
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Acupuncture
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- Annual review; no changes
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Anesthesia
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- Annual review
- Included information regarding non-reimbursed surgical codes reported for general anesthesia
- Added reimbursement information for G0500
- Reorganized CRNA billing information
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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
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Assisted Reproductive Technology
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- Updated fee for vial of sperm
- Added specific NPI billing instructions
- Updated storage information for embryos, sperm, and oocytes
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Bilateral Services
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- Annual review
- Edited to clarify coding edit for bilateral radiology procedures
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Cardiology Services
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Community Mental Health Centers
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- Annual review; no changes
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Evaluation and Management
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- 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
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Gastroenterology
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- Added coding guidelines for follow up colonoscopy
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Immunizations
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- Annual review
- Edited to clarify diagnosis codes Z28.20 – Z28.9
- Updated information for CPT 90750
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Incident To Billing for Supervising Providers for Mental Health Services – Professional
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- 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
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Newborn and Neonatal Intensive Care Services
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- Annual review
- Edited to clarify that a new claim is required for each newborn charge
- Added CPT_HCPCS payment policy under “Related policies” section
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Non-Reimbursable Services
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- Updated links to non-reimbursable list for professional providers and non-reimbursable list for facility providers
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Obstetrical and Maternity Care
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- Annual review
- Added Certified Nurse Midwives payment policy under “Related policies” section
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Oncology
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- Annual review
- Added information regarding Z5111 and Z5112 edits for coding clarity
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Orthopedic
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- Annual review
- Edited to clarify non-reimbursed robotic surgical services
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Physician Assistant and Physician Assistant PCP |
- Updated to include psychiatric PA’s may provide behavioral health services
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PT/OT- Independent Practice
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- Annual review
- Added modifiers CO and CQ to coding grid
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Telehealth (Telemedicine) – Medical Services
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- 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”
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Telehealth (Telemedicine) – Mental Health
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- 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
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Urgent Care Center
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- Annual review; no changes
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Vision Services
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- Added CPT 67031 and 66821 to coding grid
- Included information for Medicare Advantage non-routine claim submission
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