Tagged with CPT Coding
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.
For dates of service on or after December 1, 2017, Anthem Blue Cross and Blue Shield (Anthem BCBS) will begin reimbursement for Psychiatric Care Collaborative Management Healthcare Common Procedure Coding System (HCPCS Level II) codes.
Cigna has updated their precertification list to include new 12 Proprietary Laboratory Analyses (PLA) codes.
Effective for dates of service beginning January 1, 2018, Harvard Pilgrim will cover 3D mammography (digital breast tomosynthesis (DBT)) for screening or diagnostic purposes for members of its Connecticut plans.
Humana has issued several CPT code edits for specialties including Surgery, Pathology, and Radiology.
Beginning November 1, UnitedHealthcare (UHC) will require a new online notification/prior authorization process for genetic and molecular lab tests for their Commercial benefit plan members.
Effective December 15, Blue Cross and Blue Shield of Illinois (BCBSIL) will implement edits to validate National Drug Code (NDC)s that are submitted on electronic and paper, professional and institutional Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) claims.
Aetna has released updated clinical, payment and coding policy positions, including correct coding of hospital observation, critical care, admission and discharge services, changes to the assistant surgeon list and the pass-through billing policy.