Medical Policy Updates

Notification of Reimbursement Policy Revisions Effective June 1, 2022 (Posted March 31, 2022)

Reimbursement Policy Revision
Add-on codes New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Anesthesia, Professional and Facility New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Bundling guidelines Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Co-surgeon, assistant surgeon, team surgeon and assistant-at-surgery guidelines Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Consistency guidelines Policy language updated throughout. Age group definitions updated. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Diagnosis validity & code guidelines New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Evaluation and management services Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Facility billing guidelines New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Global surgery New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Guidelines for Global Maternity Reimbursement Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Immunization guidelines Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Maximum Units of Service Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Modifier guidelines Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
NCCI editing New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Observation New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Once in a Lifetime Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Outpatient Code Editor (OCE) edits Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Partial hospitalization and intensive outpatient programs Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Place of Service New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Pricing and adjudication principles Policy renamed from “Pricing and Adjudication Principles for Professional Providers” to “Pricing and Adjudication Principles”. Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Radiation therapy services Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Revenue codes requiring procedure codes, facility New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Split surgical package Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Status codes Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Supply and Equipment Reimbursement Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.