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Updated payment policies now available
October 2, 2023

This article is for all providers caring for our members

The following payment policies, updated in Q3 2023, are now available on Provider Central.

The following payment policies, updated in Q3 2023, are now available on Provider Central.

Payment policy Updates
COVID-19 Public Health Emergency temporary payment policy
  • Updated to indicate that specimen collection code 99001 will no longer be reimbursed as of September 1, 2023
  • Updated to indicate revised EUA designations effective June 1, 2023
  • Updated to indicate deleted codes for vaccines and vaccine administration
Drug Testing
  • Annual review
  • Made various edits to clarify content
Early Intervention
  • Annual review; no changes
Electronic Funds Transfer (EFT)
  • Edited to clarify dental provider information
  • Added codes effective January 1, 2024: 80305, 80307, 90966, 93294, 95250, 99291, 99366, 99368, 99453, 99454, 99457, 99468, 99471, 99475, 99489, 99492, 99493, G0480, G0481, G0482, G2066
General Coding and Billing
  • Added information about claim edits for drugs and biologics
Hospital Outpatient Fee Schedule
  • Annual review; updated template
  • Removed link to the recently retired Hospital-Salaried Physicians – Facility payment policy
  • Added existing policy statement for hospital-salaried physicians
Hospital-Salaried Physicians – Facility
  • This policy is being retired and will be removed from Provider Central
Laboratory and Pathology
  • Added information on surgical pathology billing guidelines for prostate needle biopsy effective October 1, 2023
  • Removed reference to COVID-19 in header
Late Charges – Facility
  • Annual review
  • Edited to clarify frequency code grid
Maximum Units
  • Annual review; no changes
Non-Reimbursable Services
  • Updated links for non-reimbursed list for professional providers and non-reimbursed list for facility providers
Obstetrical and Maternity Care
  • Annual review
  • Added Surgery and Newborn and Neonatal payment policies as related policies
  • Added ICD-10 CM coding guidance information and ACOG guidance for reporting E/M services
  • Added birthing center codes
Radiation Oncology
  • Annual review
  • Added IMRT, 3D Planning, and Frequency information
Speech Language Therapy
  • Annual review; updated template
  • Made various edits to clarify content
  • Added 92630 to Speech Therapy fee schedule effective September 1, 2023

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.