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Updated payment policies now available
April 1, 2024

This article is for all providers caring for our members

The following payment policies, updated in Q1 2024, are now available on Provider Central.

Payment policy Updates
Allergy Services
  • Annual review; no edits
Chiropractic
  • Annual review
  • Removed reference to 2022 date
Community Mental Health Centers
  • Added reimbursement information for certain state designated CMHCs that are contracted for community behavioral health services
CPT and HCPCS Modifiers
  • Updated modifier 59 code pairs list
Diabetic Care  
  • Annual review
  • Added A4253, A4259, and E2103
  • Added frequency for G9886 and G9887
Durable Medical Equipment  
  • Annual review
  • Updated compression stocking/garment information
  • Added L8035 as not reimbursed for Medicare Advantage
Evaluation and Management
  • Added reimbursement information effective July 1, 2024 for Medicare Advantage: we will no longer separately reimburse preventive medicine E/M visits (99381-99397) when reported with an annual well visit (G0438-G0439) on the same date of service for the same member
Gastroenterology  
  • Annual review
  • Removed reference to appendix G
Immunizations
  • Added billing information for 90678
Mental Health and Substance Use
  • Added billing information for annual mental health wellness exam as required by the Addressing Barriers to Care (ABC) Act effective March 31, 2024
Obstetrical and Maternity Care
  • Added RSV vaccine code 90678 and billing information
Podiatry  
  • Annual review; no edits
Radiology- Multiple Imaging
  • Annual review
  • Removed old effective dates
  • Corrected 12/31/23 history 76803 to 78306
Respiratory Durable Medical Equipment (DME)
  • Annual review
  • Added Non-Reimbursable Services to related payment policies
Telehealth (Telemedicine) – Medical Services
  • Added codes to the list of face-to-face medical services eligible to be performed via telehealth and/or telephone, and reimbursable telephonic and telehealth services
Telehealth (Telemedicine) – Mental Health
  • Added codes to the list of face-to-face medical services eligible to be performed via telehealth and/or telephone, and reimbursable telephonic and telehealth services

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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