Screening for Hepatitis B (HBV) infection in pregnant women provides substantial benefit, reaffirms the U.S. Preventive Services Task Force (USPSTF) in their recommendation statement released last month. This determination follows their review of new evidence on the benefits and risks of screening for hepatitis B surface antigen (HBsAg). Serologic testing accurately identifies HBV infection and,…
This recurring update notification provides the availability of payment allowances for the seasonal influenza virus vaccines as updated on an annual basis, effective August 1 of each year. The Medicare Part B payment allowance limits for seasonal influenza and pneumococcal vaccines are 95% of the Average Wholesale Price (AWP) as reflected in the published compendia…
As part of the Patient Protection and Affordable Care Act (PPACA) regulations, CPT 90461 code is not reimbursable for vaccines administered to Medicaid members through the Vaccines for Children (VFC) program in Florida. Beginning Aug. 15, 2019, any claim line billed for this code will be denied Source: https://www.uhcprovider.com/content/provider/en/viewer.html?file=%2Fcontent%2Fdam%2Fprovider%2Fdocs%2Fpublic%2Fresources%2Fnews%2F2019%2Fnetwork-bulletin%2FSeptember-2019-Network-Bulletin.pdf
Deleted Codes: J1942 Injection, aripiprazole lauroxil, 1 mg S1090 Mometasone furoate sinus implant, 370 micrograms Revised Codes: J0641 Inj., levoleucovorin, 0.5 mg J2794 Inj., risperdal consta, 0.5 mg J7311 Inj., retisert, 0.01 mg J7313 Inj., iluvien, 0.01 mg Q4122 Dermacell, awm, porous sq cm Q4165 Keramatrix, Kerasorb sq cm Q4184 Cellesta or duo per sq…
Anthem has sent out a notice to all providers who have signed non-Medicare (Commercial) or Medicare Advantage contracts with them, stating as, “Effective for all commercial and Medicare Advantage Professional Claims submitted to the plan on or after Oct. 1, 2019, the Anthem Blue Cross and Blue Shield (Anthem) Provider Agreement(s) will be amended to…
The MACs to implement logic that ensures they bypass payment window edits (3-days and 1-day) when processing claims for donor post-kidney transplant complications services. MACs will hold certain claims, as noted below, until Medicare’s Common Working File (CWF) system edits these claims correctly. 3-Day Payment Window Edits: 7109: Outpatient Diagnostic Service against Inpatient in history…
New Codes: J0121 Injection, omadacycline, 1 mg J0122 Injection, eravacycline, 1 mg J0222 Injection, Patisiran, 0.1 mg J0291 Injection, plazomicin, 5 mg J0593 Injection, lanadelumab-flyo, 1 mg (code may be used for Medicare when drug administered under direct supervision of a physician, not for use when drug is self-administered) J 1096 Dexamethasone, lacrimal ophthalmic insert,…
For World Hepatitis Day on July 28, 2019, learn more about the different types of viral hepatitis and how to take action. Worldwide, 300 million people are living with viral hepatitis unaware. Most people with chronic hepatitis virus do not have symptoms until the later stages of the infection. This puts them at risk for…
The Center’s for Medicare & Medicaid Services (CMS) just released the updated 2019 ASP drug pricing files for July. These files contain the payment amounts to be used to pay for Part B covered drugs in the third quarter. Updated July 2019 payment limits are also available; effective July 1, 2019, through September 30, 2019. Comparing…
The procedures include vascular access, catheterization, balloon valvuloplasty, valve deployment and (as needed) repositioning, temporary pacemaker insertion for rapid pacing, and access site closure. 0483T CPT Code Transcatheter mitral valve implantation/replacement (TMVI) with prosthetic valve; percutaneous approach, including trans-septal puncture, when performed 0484T CPT Code Transthoracic exposure (eg, thoracotomy, transapical) How to Avoid Denials? 1….