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Updated payment policies now available
January 4, 2024

This article is for all providers caring for our members

The following payment policies, updated in Q4 2023, are now available on Provider Central.

Payment policy Updates
Assisted Reproductive Technology
  • Annual review
  • Added billing scenarios for S4023
Audiology
  • Annual coding update
  • Added codes 92622 and 92623
Diabetic Care
  • Annual coding update
  • Added three new diabetes prevention program codes: G9886-G9888
Durable Medical Equipment
  • Annual coding update
  • Replaced deleted code K1005 with new code A4287
Evaluation and Management
  • Annual coding update
  • Added community health integration codes (G0019, G0022, G0136) as reimbursed for Medicare Advantage only
  • Added principal illness navigation codes (G0023, G0024, G0140, G0146) as reimbursed for Medicare Advantage only
  • Added G2211, visit complexity, as reimbursed for Medicare Advantage only
  • 99238-9 billing correction
Expanded Molecular Panel Testing of Cancers
  • Annual coding update
  • Added new genomic sequence panel codes 81457-81459, 81462-81464
Family Planning
  • Annual coding update
  • Added code 99459, pelvic exam
General Coding and Billing
  • Annual coding update
  • Expanded range of Category III CPT codes and “M” measurement HCPCS codes
Immunizations
  • Annual coding update
  • Added vaccine codes 90679, 90589, 90623, 90683, 90380, and 90381
  • Added RSV admin codes 96380-81
Mental Health and Substance Use
  • Annual coding update
  • Added code G0137 for Medicare Advantage only
  • Added codes G0017 and G0018
Non-Reimbursable Services
  • Annual coding update
  • Updated new, revised, and deleted codes
Obstetrical and Maternity Care
  • Annual coding update
  • Added code 99459
Oncology
  • Annual coding update
  • Added codes 96457, 96458
PT/OT- Independent Practice
  • Annual coding update
  • Added January 1, 2024 codes 98975-98977, 98980-98981
  • Added new codes 97550-97552
Radiology- Multiple Imaging
  • Annual coding update
  • Added existing codes 96803, 78802, 78803
  • Added new 2024 codes 76984, 76987-76989, 0865T
Speech Language Therapy
  • Annual coding update
  • Added codes 97550-97552
Surgery-Professional
  • Annual coding update
  • Added codes 22836-22838
Telehealth (Telemedicine) – Medical Services
  • Added code 97535 to list of face-to-face medical services eligible to be performed via telehealth
  • Added code G2211 to list of face-to-face medical services eligible to be performed via telehealth for Medicare Advantage only
  • Edited to clarify documentation requirements for telehealth
  • Added January 1, 2024 reimbursement information about acute rehabilitation and long-term care hospital facility UB04 claim billing
Telehealth (Telemedicine) – Mental Health 
  • Added code 97535 to list of face-to-face medical services eligible to be performed via telehealth
  • Added code G2211 to list of face-to-face medical services eligible to be performed via telehealth for Medicare Advantage only
  • Edited to clarify documentation requirements for telehealth
  • Added January 1, 2024 reimbursement information about acute rehabilitation and long-term care hospital facility UB04 claim billing

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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