Tagged with CPT Coding
Effective July 1, UnitedHealthcare (UHC) will expand the existing prior authorization/notification for genetic and molecular testing performed in an outpatient setting.
Anthem New Partial Hospitalization Program and Intensive Outpatient Program Services Facility Reimbursement Policy
Beginning with dates of service on or after July 1, Anthem Blue Cross and Blue Shield (Anthem) will implement the new facility reimbursement policy, Partial Hospitalization Program and Intensive Outpatient Program Services.
Cigna has issued several updates to its precertification list for April 2019.
UHC has posted a correction to authorization previously published code additions, as well as new codes requiring prior authorization.
On April 1, CMS released its finalized payment and policy changes for Medicare Advantage (MA) and Medicare Part D plans for the 2020 coverage year. CMS states the final updates will continue to maximize competition among Medicare Advantage and Part D plans, as well as include important actions to address the nation’s opioid crisis.
CMS has announced plans to analyze whether clinical labs improperly unbundled Medicare billing codes for panel diagnostic tests in order to receive higher payments.
Aetna has issued an update regarding the use of CPT II codes for HEDIS® high blood pressure measurements for patients diagnosed with hypertension.
Anthem has posted several reimbursement policy updates, including updates to its Rule of Eight” Reporting Guidelines, system updates for 2019, and updates to policy for Modifier 69.
On November 1, CMS issued the Calendar Year (CY) 2019 Medicare Physician Fee Schedule (PFS) final rule. The final rule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2019.
CMS has released its final 2019 Medicare clinical laboratory fee schedule (CLFS) payment determinations for new and reconsidered clinical lab test codes. Specifically, CMS finalized the basis for establishing the payment rate (crosswalking or gapfilling), along with the agency’s rationale for the decision.
Anthem is updating its editing systems to automate edits supported by correct coding guidelines, as documented in industry sources such as CPT®, HCPCS Level II, and ICD-10. Anthem states the enhanced editing automation will promote faster claim processing and reduce follow-up audits and/or record requests for claims not consistent with correct coding guidelines.
Cigna has published a number of clinical, reimbursement, and administrative policy updates, including its reimbursement policy for Infusion and Injection Administration Services with Emergency Department as Place of Service and precertification changes for Cardiac Electrophysiological Studies.
Humana recently published new updates to its claim payment policy for pass-through billing as well as its policy for telehealth and telemedicine.
CMS has released its Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule for the next calendar year. According to the agency, the policies adopted in the CY 2019 final rule will help lay the foundation for a patient-driven healthcare system and will also strengthen the Medicare program by providing more choices and lower cost options.
CMS has released its October addenda, providing fourth quarter updates to the ASC payment system.
Humana has posted a number of policy and claims payment system updates, that will become effective in October.
Cigna has updated their precertification list to include 27 new CPT® codes and seven new HCPCS codes to its precertification list.
Florida Blue issued a notice to providers stating the insurer will implement edits for several spinal surgery procedures when billed in conjunction with lumber spinal fusion codes, including spinal cord decompression and laminectomy, facetectomy and foraminotomy procedures.
Following Blue Cross and Blue Shield of Vermont’s (BCBSVT) review of the CPT® and HCPCS additions, deletions and revisions for October 1, the insurer has made several changes involving prior approval, investigational services, and unit designation.
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.