Tagged with CPT Coding
UHC Updates Requirements for Specialty Medical Injectable Drugs
Effective October 1, 2019, Optum will make changes to and start managing prior authorization requests and processes for certain medical benefit injectable medications for UnitedHealthcare (UHC) commercial plan members.
New Jersey – UHC Outpatient Injectable Cancer Therapy Prior Authorization Requirement
Effective October 1, an affiliate company of UnitedHealthcare (UHC), will begin managing the insurer’s prior authorization requests for outpatient injectable chemotherapy and related cancer therapies for (UHC) Community Plan members in New Jersey.
Aetna Wisconsin Issues New Preapproval Requirements for Members
Effective July 1, Aetna will require prior authorization for certain procedures under its Enhanced Clinical Review Program with eviCore healthcare.
Cigna Clinical, Reimbursement, and Administrative Policy Updates
Cigna has published a number of clinical, reimbursement, and administrative policy updates, including its reimbursement policy for spinal fusion related services, venous angioplasty, and orthotic prescriptions.
Anthem Posts Bundled Services and Frequency Editing Reimbursement Policies Updates
Beginning with dates of service November 1, Anthem will implement updates Bundled Services and Supplies and Frequency Editing reimbursement policies.
Aetna Issues New Radiation Therapy Preapproval Requirements
Beginning July 1, Aetna will require authorization for its enhanced clinical review program with eviCore healthcare for certain outpatient radiation therapy services.
Aetna Issues ASC and Ambulatory Payment Classification (APC) Code Edit Updates
Aetna has released updates regarding how the insurer will handle certain ambulatory surgical center (ASC) and ambulatory payment classification (APC) code edits under the ASC and APC payment methodologies.
Anthem Announces Fee Schedule Changes
Anthem Blue Cross and Blue Shield (Anthem) recently notified members of the upcoming changes to its Anthem Plan Fee Schedules, scheduled to take place July 1.
Atena Updates Payment Process for Certain ASC and APC Code Edits
Aetna has posted updated information regarding how the insurer will handle certain Ambulatory Surgical Center (ASC) and Ambulatory Payment Classification (APC) code edits under the ASC and APC payment methodologies.
United Healthcare Announces Coordinated Commercial Reimbursement Policy Changes
UnitedHealthcare has released changes to its coordinated commercial reimbursement policy, which includes updates to its procedure to modifier policy and consultation services policy.
UHC Genetic and Molecular Lab Testing Prior Authorization Requirement
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 Precertification Updates
Cigna has issued several updates to its precertification list for April 2019.
UnitedHealthcare Changes in Advance Notification and Prior Authorization Requirements
UHC has posted a correction to authorization previously published code additions, as well as new codes requiring prior authorization.
CMS Releases 2020 Medicare Advantage and Part D Rates
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 Takes Aim at Potentially Inappropriate Medicare Lab Test Billing
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 Update for CPT II Codes for High Blood Pressure Measurements
Aetna has issued an update regarding the use of CPT II codes for HEDIS® high blood pressure measurements for patients diagnosed with hypertension.
New York – Anthem Reimbursement Policy Updates
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.
CMS Publishes Final CY 2019 Medicare Physician Fee Schedule Rates and Policies
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 Finalizes 2019 Medicare Clinical Lab Payment Determinations
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.
