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Updated payment policies now available
June 30, 2023

This article is for all providers caring for our members

The following payment policies, updated in Q2 2023, are now available on Provider Central.

Payment policy Updates
Anesthesia
  • Annual review
  • Added modifier 23 to informational-only modifiers
  • Added definition of reportable anesthesia time
  • Added 01996 to coding grid
COVID-19 Public Health Emergency temporary payment policy
  • Updated vaccine administration descriptions and EUA designations
  • Updated specimen collection guidelines to indicate deleted codes
CPT and HCPCS Modifiers
  • Annual review
  • Added reimbursement information for FX and FY modifier
Dental Care
  • Annual review; no updates
Durable Medical Equipment
  • Added A4253 and A4259
  • Updated coverage of A9276, A9277, and A9278 for Medicare Advantage products
Evaluation and Management
  • Annual review
  • Edited to clarify NP/PA as they relate to new patients
  • Updated 99281-5 code level selection instructions
  • Removed statement regarding admitting a patient after being seen in a different place of service
  • Removed 1995 and 1997 CMS documentation guidelines
General Coding and Billing
  • Annual review
  • Expanded range of Category III CPT codes
Human Leukocyte Antigen
  • Annual review; no updates
Immunizations
  • Annual review
  • Updated pharmacy provider to CVS Caremark
  • Updated vaccine and toxoid code range
Medical Nutrition Therapy/Licensed Dietician Nutritionist
  • Annual review; no updates
Mental Health and Substance Use
  • Annual review; no updates
Serious Reportable Events
  • Annual review
  • Updated billing instructions to specify not to bill for services related to preventable Serious Reportable Events
Surgery- Professional
  • Annual review
  • Added modifiers FT and 25
  • Edited to clarify guidelines on reporting services with 1 unit only
  • Expanded skin substitute code range
Telehealth (Telemedicine) – Medical Services
  • Edited to clarify telehealth reimbursement guidelines
Telehealth (Telemedicine) – Mental Health
  • Edited to clarify telehealth reimbursement guidelines

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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