Tagged with CPT Coding
Cigna Requirement to Precertify Oncology Medications
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.
UnitedHealthcare Prior Authorization and Coding Policy Updates
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 New and Revised Medical Coverage Policies
Humana has released two new medical coverage policies and several updates to policies effective at the start of the new year.
Florida Outpatient Injectable Chemotherapy Notification for UHC MA Plans
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.
Indiana Medicaid Medical Policy Updates
Anthem BCBS of Indiana has issued notice of medical policy revisions approved by the Medical Policy and Technology Assessment Committee (MPTAC).
Health New England Updates Anesthesia Guidelines
Healthcare New England (HNE) has issued updated anesthesia guidelines surrounding the use CPT codes and claim submissions.
Medicare HOPPS, ASC Rates and Policies Finalized for CY 2018
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).
New Positron Emission Tomography Radiopharmaceutical/Tracer Unclassified Codes
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.
Anthem Integrated Medical and Behavioral Healthcare Reimbursement Policy Update
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 Precertification Policy Updates for Proprietary Laboratory Analyses
Cigna has updated their precertification list to include new 12 Proprietary Laboratory Analyses (PLA) codes.
Harvard Pilgrim CT Policy Updates for 3D Mammography Coverage
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 CPT Code Edits for Certain Specialties
Humana has issued several CPT code edits for specialties including Surgery, Pathology, and Radiology.
UHC Genetic and Molecular Lab Testing Prior Authorization Requirement
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.
IL BCBSIL NDC Billing Update for Medicare Advantage Claims
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 Clinical Payment, Coding and Policy Updates
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.
Cigna Medical Policy Updates
Cigna has posted updates to specific medical and preventive care services policies, including its uniform billing editor, pharmacy and infusion services, and omnibus reimbursement.
2018 eCQM Value Set Addendum for EPs, ECs Released
CMS has released an addendum to the electronic clinical quality measure (eCQM) annual update specifications originally published in May 2017. This addendum updates eCQM value sets for the 2018 performance period for Eligible Professionals (EPs) and Eligible Clinicians (ECs).
CPT 2018 Update Brings New E/M Codes, Mass Revisions and Revised Guidelines
A total of 314 code changes have been implemented throughout the 2018 CPT manual. Of these changes, Anesthesia will see four changes to observation E/M codes, the addition of five gastro-endoscopic procedure codes, and three low-volume codes have been deleted.
UHC – Genetic and Molecular Testing Prior Auth. Requirement
Effective Nov. 1, UnitedHealthcare will start its online prior authorization/notification program for genetic and molecular testing performed in an outpatient setting for fully insured UnitedHealthcare Commercial Plan members. Providers requesting laboratory testing will be required to complete the prior auth. process as well as indicate the laboratory and test name for specific services.
Anthem BCBS – Medical Policy and Clinical Guideline Updates
Anthem Blue Cross and Blue Shield released updated medical policies and clinical guidelines to be implemented on November 1, 2017 in certain states.
