Tagged with CPT Coding
Telehealth Benefits Temporarily Expanded
The White House has announced that beginning on March 6, Medicare administered by CMS will temporarily pay clinicians to providing virtual visits and other telehealth services to beneficiaries.
CPT® Releases New Coronavirus (COVID-19) Code & Description for Testing
A new CPT® code has been created that streamlines novel coronavirus testing offered by hospitals, health systems and laboratories in the United States. The new code became effective March 13, 2020 for use as the industry standard for reporting of novel coronavirus tests across the nation’s health care system.
Ohio Revises Definition of Ambulatory Surgical Facilities
Ohio has released the recently revised definition of an Ambulatory Surgical Facility (ASF), as part of the new 2020/2021 general operating budget legislation. The change expanded the ASF definition, which may require some previously unlicensed facilities to obtain licensure.
Anthem Outpatient Facility Edit Implementation
Effective April 26, Anthem Blue Cross Blue Shield (Anthem) will make changes to its outpatient facility edits for revenue codes, CPT® codes, HCPCS and modifiers. These edits will include changes to appropriate use of various code combinations, such as, procedure code to revenue code, HCPCS to revenue code, type of bill to procedure code, type of bill to HCPCS code, procedure code to modifier, and HCPCS to modifier.
CMS Develops New Code for Coronavirus Lab Test
On February 13, CMS introduced a new code that enables labs conducting Coronavirus tests to bill for the specific test instead of using an unspecified code.
Cigna Clinical, Reimbursement, and Administrative Policy Updates
Cigna has released its latest clinical, reimbursement, and administrative policy updates, which includes policy updates for certain anesthesia services, care integration services, and E & M services.
CMS Releases 2021 MA and Part D Advance Notice Part II
On February 5, CMS released Part II of the Calendar Year (CY) 2021 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies. In the CY 2021 Advance Notice, the agency is proposing updates and changes to the methodologies used to pay MA plans, Programs of All-Inclusive Care for the Elderly (PACE) organizations, and Part D sponsors.
FDA Issues Gene Therapy Guidances
On January 28, the FDA issued six final guidances on gene therapy manufacturing and clinical development of products, as well as a draft guidance, describing the agency’s proposed approach to determining sameness of gene therapy products for orphan drug designation and exclusivity purposes.
CMS Publishes FY 2022 SNF APU Overview Table
CMS, on January 30, published the Fiscal Year (FY) 2022 Skilled Nursing Facility (SNF) Annual Payment Update (APU) table, indicating the data elements the agency will use for FY 2022 SNF Quality Reporting Program APU determinations.
Anthem CT Outpatient Facility Edit Implementation
Beginning with claims processed on and after April 26, 2020, Anthem Connecticut will be enhancing its outpatient facility edits for revenue codes, Current Procedural Terminology (CPT®) codes, Healthcare Common Procedure Coding System (HCPCS) and modifiers.
UHC Radiology Program Procedure Code Changes
Effective January 1, UnitedHealthcare (UHC) will update the procedure code list for the Radiology Notification and Prior Authorization programs based on code changes made by the American Medical Association (AMA). Claims with dates of service on or after January 1 are subject to these changes.
Aetna Experimental and Investigational Labs Coverage Reminder
Aetna has issued a reminder for patient and provider regarding coverage of certain experimental and investigational laboratory tests.
Senate, House Announce Surprise Billing Deal
House and Senate Committee Leaders have announced that the Senate Health, Education, Labor and Pensions (HELP) Committee and the House Energy and Commerce Committee have reached a bipartisan agreement on legislation to address surprise billing, including an arbitration process and provisions to lower out-of-pocket health care expenses.
Aetna Issues Notice of Pay Percent Reduction for Multiple Endoscopies
Aetna has issued a notice, informing providers that, at the end of this year, the insurer will adjust payment for multiple endoscopy procedures in the same family.
Humana Releases Latest Claims Payment Policy Updates
Humana has published its latest medical claims payment policy updates, including its reimbursement policy for ambulance transportation, requirements for billing and documentation of observation services, as well as a new policy for obstetric billing, including antepartum, delivery and postpartum care.
UnitedHealthcare Expands Prior Auth Requirements and Site-of-Service Medical Necessity Reviews for Certain Surgeries
UnitedHealthcare has expanded prior authorization requirements and site of service medical necessity reviews for certain surgeries in an effort to shift surgical procedures to less expensive locations.
Executive Order Issued to Protect Traditional Medicare and MA Plans
The president, on October 3, signed an executive order directing the Department of Health and Human Services to increase efforts to provide more insurance plan options under Medicare Advantage and to remove regulations that are considered burdensome to health care providers. The order is intended to protect traditional Medicare and private Medicare Advantage while ramping up alternative payment models, time spent with patients, access to innovative technology and reducing the regulatory burdens on providers.
Improper Payment for Intensity-Modulated Radiation Therapy Planning Services
In a recent report, the Office of Inspector General (OIG) determined that payments for outpatient Intensity Modulated Radiation Therapy (IMRT) did not comply with Medicare billing requirements. Specifically, hospitals billed separately for complex stimulations when they were performed as part of IMRT planning. Overpayments occurred because hospitals are unfamiliar with or misinterpreted CMS guidance.
Anthem Blue Cross Blue Shield Clinical, Medical, and Coding Updates
Anthem BCBS has posted its recent Clinical, Medical, and Coding Updates, including revisions to Gene Therapy for Spinal Muscular Atrophy guidelines and changes to Positron Emission Tomography (PET) guidelines.
Cigna Preventive Care Services Policy & Precertification Updates
Cigna has made several additions and removals to its precertification list, as well as updates to its Preventive Care Services Policy.
