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Reimbursement Policy Update for December 31, 2022
| Commercial Reimbursement Policy | Reason for Update |
|---|---|
| Routine Policy Review. Minor revisions only | |
| Routine policy review. Removed information pertaining to COVID-19 Public Health Emergency (PHE) Face to Face exception. Please reference Telehealth Policy. | |
| Routine policy review. Minor revisions in formatting only. | |
| Anesthesia, Professional and Facility (PDF) | Routine Policy Review. Minor revisions only. |
| Bundling Guidelines (PDF) | Routine policy review. Added new 2023 codes. Medical Director approved. |
| Co-Surgeon, Assistant Surgeon, and Assistant-at-Surgery Guidelines (PDF) | Routine policy review. Minor revisions only. |
| Consistency Guidelines (PDF) | Routine policy review. Minor revisions only. |
| Developmental Delay Screening and Testing Guidelines (PDF) | Routine policy review. Minor revisions only. |
| Diagnosis Validity & Code Guidelines (PDF) | Routine policy review. Minor revisions only. |
| Discontinued Procedures (PDF) | Routine policy review. Minor revisions only. |
| Documentation Requirements for Treatment of End Stage Renal Disease (PDF) | Routine policy review. Minor revisions only. |
| ECG Reimbursement (PDF) | Routine policy review. Minor revisions only. |
| Evaluation and Management Services (PDF) | Routine policy review. Minor revisions only. |
| Facility Billing Guidelines (PDF) | Routine policy review. Alphabetized Service Descriptions. Minor revisions. |
| Global Surgery (PDF) | Routine policy review. Minor revisions only. |
| Group Visit (Shared Medical Appointment) Guidelines (PDF) | Routine policy review. Minor revisions only. |
| Guidelines for Global Maternity Reimbursement (PDF) | Routine policy review. Minor revisions only. |
| Immunization Guidelines (PDF) | Routine policy review. Clarification made to bill charge of $.01 for state supplied vaccines to mirror Bundling Guidelines. |
| Routine policy review. Minor revisions only. | |
| Maximum Units of Service (PDF) | Routine policy review. Minor revisions only. |
| Modifier Guidelines (PDF) | Routine Policy Review. Added “Refer to Telehealth Policy” under Modifier GQ description. Added link to Telehealth Policy under Related Policies. |
| Multiple Procedure Payment Reduction on the Technical Component (TC) of Diagnostic Cardiovascular and Ophthalmology Procedures (PDF) | Routine policy review. Minor revisions only. |
| Multiple Surgical Procedure Guidelines for Professional Providers (PDF) | Routine policy review. Minor revisions only. |
| NCCI Editing (PDF) | Routine policy review. Minor revisions only. |
| NDC (PDF) | Routine policy review. Minor revisions only. |
| Nonpayment for Serious Adverse Events (PDF) | Routine policy review. Minor revisions only. |
| Observation (PDF) | Routine policy review. Minor revisions only. |
| Once in a Lifetime (PDF) | Routine policy review. Minor revisions only. |
| Opioid Treatment Program Reimbursement (PDF) | Routine policy review. Minor revisions only. |
| Outpatient Code Editor (OCE) Edits (PDF) | Routine policy review. Minor revisions only. |
| Partial Hospitalization and Intensive Outpatient Programs | Routine policy review. Minor revisions only. |
| Place of Service (PDF) | Routine policy review. Alphabetized Reimbursement Guidelines section and added language for DME billing requirement for place of service. Medical Director approved. |
| Preadmission and Preoperative Services (PDF) | Routine policy review. Minor revisions only. |
| Pricing and Adjudication Principles (PDF) | Routine policy review. Minor revisions only. |
| Radiation Therapy Services (PDF) | Routine policy review. Minor revisions only. |
| Radiology Services Reimbursement Policy (PDF) | Routine policy review. Minor revisions only. |
| Reduced Services (PDF) | Routine policy review. Minor revisions only. |
| Removal of Impacted Cerumen (PDF) | Routine policy review. Minor revisions only. |
| Revenue Codes Requiring Procedure Codes, Facility (PDF) | Routine policy review. Minor revisions only. |
| Services Bundled into Inpatient / Outpatient Stays (PDF) | Routine policy review. Added clarifying language about line-items reductions under Reimbursement Guidelines. Medical Director approved. |
| Split Surgical Package (PDF) | Routine policy review. Minor revisions only. |
| Status Codes (PDF) | Routine policy review. Minor revisions only. |
| Supply and Equipment Reimbursement (PDF) | Routine policy review. Minor revisions only. |
| Extensive revision throughout policy. Reimbursement Guidelines section updated with new topics: Audio-only Telehealth, Origination Site, Online Digital Evaluation and Management Services. Billing and Coding section updated code list of telehealth services. Billing instructions updated requiring telehealth modifier and place of service codes. Medical Director approved. Notification on 9/21/2022 for effective date 1/1/2023. | |
| Unplanned Return Surgery (PDF) | Routine policy review. Minor revisions only. |
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