Tagged with CPT Coding
Effective July 1, Anthem will implement processing updates for service claims under certain programs, including radiation oncology and cardiology services, which require precertification through AIM Specialty Health® (AIM).
Effective September 1, Aetna will implement changes to its clinical payment and coding policy for several services and procedures, and will also implement several changes to its CPT® codes assigned to Enhanced Groupings (AEG) and/or Coventry Enhanced Groupings (CEG).
Beginning in July, UnitedHealthcare (UHC) will make changes to some commercial reimbursement policies, including after hours and weekend care, intraoperative neuromonitoring, and its professional and technical component policy for duplicate or repeat services of global test only.
Cigna has published a number of updates for its clinical, reimbursement, and administrative policies, including reimbursement policies for pharmacy and infusion services, cervical fusion, and cardiac ablation for supraventricular tachycardia.
Humana has published new and updated medical claims payment policy for certain CPT and diagnosis codes as well as correct coding updates, scheduled to take effect in July.
Aetna has released the most recent Current Procedural Terminology® (CPT®) codes added to Aetna Enhanced Grouper (AEG) and/or Coventry Enhanced Grouper (CEG) assignments.
Anthem Blue Cross Blue Shield (BCBS) published a notice stating that effective with dates of service on and after July 1st a separate company, AIM Specialty Health (AIM), will apply AIM’s Radiation Oncology Clinical Appropriateness Guidelines to precertification requests for certain services.
UnitedHealthcare (UHC) released a policy revision for molecular and genetic tests that have proven efficacy in the diagnosis or treatment of medical conditions.
CMS has released the latest coding changes, revisions, and feedback to National Coverage Determinations (NCDs) in the 10th revision of the ‘International Classification of Diseases (ICD-10) and Other Coding Revisions.
Blue Cross and Blue Shield of Rhode Island (BCBSRI) has updated its claims processing system. These updates became effective April 1 and include Category II performance measurement tracking codes and Category III temporary codes for emerging technology.
Blue Cross and Blue Shield of Vermont (BCBSVT) has released the list of recently updated medical policies and the corresponding effective dates.
Blue Cross Blue Shield of Massachusetts (BCBSMA) has released coding and payment updates for certain procedures and services, including venipuncture reported with labs or E&M service, interim caries arresting medicament, and others.
The Illinois Department of Health and Family Services issued a notice to remind providers of Department policy for covering multiple office or other outpatient visits and procedures on the same day.
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.
CMS will remove the prior authorization (PA) requirement for certain types of medical equipment that no longer meet standards set forth in a 2015 final rule.
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 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.
UnitedHealth Group has announced plans to introduce a new payment policy intended to reduce its emergency department claims cost.
Effective July 1, Aetna will implement changes to its clinical payment and coding policies as well as several changes to its National Precertification List (NPL).
As of March 1 for UnitedHealthcare (UHC) Medicare Advantage (MA) members in Florida and Georgia and April 1 for plans in Wisconsin, UHC will require care providers to submit a notification for injectable chemotherapy when administrated in an outpatient setting for UHC MA members with a cancer diagnosis.