Tagged with CPT Coding

Humana Claim Processing Edits

Humana has released several claims processing edits, including updates to Outpatient Prospective Payment System (OPPS), Modifiers 96 and 97, HCPCS Drugs & Biologicals, and other policies.

2019 Medicare Advantage and Part D Rates Announced

CMS has released the final policy and payment updates to the Medicare Advantage (MA) and Part D programs for 2019. The policy changes for the coming year will include a pay increase for MA plans and strategies to increase the use of encounter data to determine risk scores for plans.

Harvard Pilgrim Anesthesia for GI Endoscopic Procedures Policy Update

Harvard Pilgrim is implementing updates to its policy for Monitored Anesthesia Care for Gastrointestinal (GI) Endoscopic Procedures to include the appropriate 2018 CPT codes and to expand coverage of monitored anesthesia care to include patients at risk of complication due to mild systemic disease.

2018 CPT Changes for Orthopaedic Surgery

This year, CPT® coding updates for orthopaedic surgery includes the removal of two codes and adds one new code, as well as a number of instructional notes to clarify proper reporting of certain codes.

2018 Payment Policy for Blue Light Cystoscopy

In the CY 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule, CMS adopted a number of policies, recommended by the American Urological Association (AUA), to support urologic services such as cystoscopy.

Aetna Clinical Payment, Coding and Policy Updates

Aetna has released updated clinical, payment and coding policies, including multiple procedure reduction for diagnostic cardiology, diagnostic ophthalmology, and therapeutic services.

Cigna Requirement to Precertify Oncology Medications

Cigna has implemented an integrated oncology management program which requires providers to precertify certain medical oncology medications through a national ancillary provider (instead of Cigna), including primary chemotherapy, and supportive drugs, such as medical injectables and infusions.

Indiana Medicaid Medical Policy Updates

Anthem BCBS of Indiana has issued notice of medical policy revisions approved by the Medical Policy and Technology Assessment Committee (MPTAC).