Clinical Laboratory Improvement Amendments of 1998 (CLIA) requires that a laboratory be appropriately certified for each test it performs. The CPT codes that CMS considers to be laboratory tests under CLIA (and thus requiring certification) change each year. Listed below are the latest tests approved by the Food and Drug Administration (FDA) as waived tests…

Descriptions of 99 place of service codes can be found below. Use the POS codes to describe a place where a service was performed. Note: Reimbursement needs to be checked with the individual payers. Place Of Service 01 (POS 01) POS 01 can be used when the place of service is a pharmacy. A pharmacy…

Urgent Care Centers are the Facilities that delivers Outpatient Medical Care usually for the conditions that does not require Hospital admission. Urgent care centers are primarily used to treat patients with acute and chronic injury or illness (that are not life-threatening conditions for the patient) that requires immediate attention. Urgent care Facilities are designed to…

AAPC’s Certified Professional Coder (CPC) credential is the gold standard for medical coding in physician office settings and is held by more than 60,000 coding professionals. CPC’s are critical to compliant and profitable medical practices and typically earn 20% more than non-certified coders. The CPC increases your chances of hiring and retaining in a competitive…

Aetna considers chiropractic services medically necessary when all of the following criteria are met: If no improvement is documented within the initial two weeks, additional chiropractic treatment is considered not medically necessary unless the chiropractic treatment is modified. If no improvement is documented within 30 days despite modification of chiropractic treatment, continued chiropractic treatment is…

Obstetrics and Gynaecology / Maternity care services;  1. Antepartum care2. Delivery services3. Postpartum care The two types of OB coding & billing guidelines are given below, 1. Global OB Care2. Non-global OB care or partial services Global OB Care The total obstetric care package includes antepartum care, delivery services, and postpartum care. When the same…

Payment rates for an individual service are based on the following three components: Each component is discussed in more detail below. 1) Relative Value Units (RVU) Three separate RVUs are associated with the calculation of payment under the Medicare PFS: ™Work RVUs reflect the relative levels of time and intensity associated with furnishing a Medicare PFS…

Does Aetna cover mammograms? Aetna considers annual mammography screening a medically necessary preventive service for women aged 40 and older. Annual screening is also considered medically necessary for younger women judged high-risk by their primary care physician. Screening mammography for other women is considered experimental and investigational because its benefits in these other women are…

There are two versions of the documentation guidelines – the 1995 version and the 1997 version. The most substantial difference between 95 and 97 guidelines occur in the examination documentation section. Either version of the documentation guidelines, not a combination of the two, may be used by the provider for a patient encounter. 1995 E/M…

CIGNA covers chiropractic manipulation services and adjunct therapeutic modalities if they are medically necessary. Read on about CIGNA coverage, documentation, and chiropractic services that are not covered.  1. Does CIGNA Cover Chiropractic Services? Chiropractic manipulation and adjunct chiropractic services or mobilities (for example, traction or therapeutic exercise) are covered by CIGNA if the conditions below…