Medical Policy Updates

Reimbursement Policy Update for December 31, 2022

Commercial Reimbursement Policy	Reason for Update
Add-On Codes	Routine Policy Review. Minor revisions only
Advanced Illness / Advance Directives	Routine policy review. Removed information pertaining to COVID-19 Public Health Emergency (PHE) Face to Face exception. Please reference Telehealth Policy.
Ambulatory Surgical Center (ASC) Reimbursement	Routine policy review. Minor revisions in formatting only.
Anesthesia, Professional and Facility	Routine Policy Review. Minor revisions only.
Bundling Guidelines	Routine policy review. Added new 2023 codes. Medical Director approved.
Co-Surgeon, Assistant Surgeon, and Assistant-at-Surgery Guidelines	Routine policy review. Minor revisions only.
Consistency Guidelines	Routine policy review. Minor revisions only.
Developmental Delay Screening and Testing Guidelines	Routine policy review. Minor revisions only.
Diagnosis Validity & Code Guidelines	Routine policy review. Minor revisions only.
Discontinued Procedures	Routine policy review. Minor revisions only.
Documentation Requirements for Treatment of End Stage Renal Disease	Routine policy review. Minor revisions only.
ECG Reimbursement	Routine policy review. Minor revisions only.
Evaluation and Management Services	Routine policy review. Minor revisions only.
Facility Billing Guidelines	Routine policy review. Alphabetized Service Descriptions. Minor revisions.
Global Surgery	Routine policy review. Minor revisions only.
Group Visit (Shared Medical Appointment) Guidelines	Routine policy review. Minor revisions only.
Guidelines for Global Maternity Reimbursement	Routine policy review. Minor revisions only.
Immunization Guidelines	Routine policy review. Clarification made to bill charge of $.01 for state supplied vaccines to mirror Bundling Guidelines.
Inpatient Readmission	Routine policy review. Minor revisions only.
Maximum Units of Service	Routine policy review. Minor revisions only.
Modifier Guidelines	Routine Policy Review. Added “Refer to Telehealth Policy” under Modifier GQ description. Added link to Telehealth Policy under Related Policies.
Multiple Procedure Payment Reduction on the Technical Component (TC) of Diagnostic Cardiovascular and Ophthalmology Procedures	Routine policy review. Minor revisions only.
Multiple Surgical Procedure Guidelines for Professional Providers	Routine policy review. Minor revisions only.
NCCI Editing	Routine policy review. Minor revisions only.
NDC	Routine policy review. Minor revisions only.
Nonpayment for Serious Adverse Events	Routine policy review. Minor revisions only.
Observation	Routine policy review. Minor revisions only.
Once in a Lifetime	Routine policy review. Minor revisions only.
Opioid Treatment Program Reimbursement	Routine policy review. Minor revisions only.
Outpatient Code Editor (OCE) Edits	Routine policy review. Minor revisions only.
Partial Hospitalization and Intensive Outpatient Programs	Routine policy review. Minor revisions only.
Place of Service	Routine policy review. Alphabetized Reimbursement Guidelines section and added language for DME billing requirement for place of service. Medical Director approved.
Preadmission and Preoperative Services	Routine policy review. Minor revisions only.
Pricing and Adjudication Principles	Routine policy review. Minor revisions only.
Radiation Therapy Services	Routine policy review. Minor revisions only.
Radiology Services Reimbursement Policy	Routine policy review. Minor revisions only.
Reduced Services	Routine policy review. Minor revisions only.
Removal of Impacted Cerumen	Routine policy review. Minor revisions only.
Revenue Codes Requiring Procedure Codes, Facility	Routine policy review. Minor revisions only.
Services Bundled into Inpatient / Outpatient Stays	Routine policy review. Added clarifying language about line-items reductions under Reimbursement Guidelines. Medical Director approved.
Split Surgical Package	Routine policy review. Minor revisions only.
Status Codes	Routine policy review. Minor revisions only.
Supply and Equipment Reimbursement	Routine policy review. Minor revisions only.
Telehealth	Extensive revision throughout policy. Reimbursement Guidelines section updated with new topics: Audio-only Telehealth, Origination Site, Online Digital Evaluation and Management Services. Billing and Coding section updated code list of telehealth services. Billing instructions updated requiring telehealth modifier and place of service codes. Medical Director approved. Notification on 9/21/2022 for effective date 1/1/2023.
Unplanned Return Surgery	Routine policy review. Minor revisions only.