Tagged with CPT Coding
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.
Effective for dates of service on or after April 1st, several new codes will be added to UHC’s prior authorization list as a result of the American Medical Association (AMA) 2018 annual CPT® update.
As of January 1st, several CPT® code updates for emergency medicine took effect, including changes to chest x-ray and abdominal x-rays codes, lab test and needle introduction codes, observation codes, and an updated ultrasound of extremities descriptor.
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.
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 has released updated clinical, payment and coding policies, including multiple procedure reduction for diagnostic cardiology, diagnostic ophthalmology, and therapeutic services.
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.
UHC has announced two updates for notification and prior authorization on certain procedures, as well as revisions to its emergency department facility evaluation and management (e/m) coding policies.
Humana has released two new medical coverage policies and several updates to policies effective at the start of the new year.
On March 1, 2018, UnitedHealthcare MA will require notification for injectable outpatient chemotherapy drugs given for a cancer diagnosis for members in Florida and Georgia.
Anthem BCBS of Indiana has issued notice of medical policy revisions approved by the Medical Policy and Technology Assessment Committee (MPTAC).
Healthcare New England (HNE) has issued updated anesthesia guidelines surrounding the use CPT codes and claim submissions.
CMS has published the final rule updating Medicare Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgical Center (ASC) Payment System rates and policies for calendar year 2018 (CY 2018).
CMS issued a notice announcing two new Positron Emission Tomography (PET) radiopharmaceutical unclassified tracer codes to be used temporarily pending the creation/approval/implementation of permanent CPT codes.