Horizon BCBSNJ Reimbursement Guidelines Changes in Outpatient Laboratory Claims

Horizon BCBSNJ Reimbursement Guidelines Changes in Outpatient Laboratory Claims

Outpatient Laboratory Claims: Referring Practitioner Required In accordance with Centers for Medicare and Medicaid Services (CMS) guidelines, Horizon BCBSNJ requires that claims for clinical laboratory services report the referring practitioner on the claim submission. This applies to participating and non-participating providers. Effective November 15, 2019 Horizon BCBSNJ will change the way consider and reimburse certain clinical…

New Reimbursement Guidelines for Smoking Cessation

Effective September 26, 2019, Horizon BCBSNJ will change the way consider certain professional claims for smoking cessation services provided September 26, 2019. In accordance with CMS guidelines, Horizon BCBSNJ shall consider for reimbursement smoking and tobacco cessation counseling visits (99406 or 99407) for asymptomatic patients when billed with an approved diagnosis code. Approved Diagnosis Codes: Nicotine dependence (F17.21-F17.299)…

Changes in Allergy Testing Guidelines

Changes in Allergy Testing Guidelines

Effective September 10, 2019, Horizon BCBSN will change the way consider certain professional claims for services provided to Horizon BCBSNJ Medicare Advantage (MA) members based on an update to our medical policy, Allergy Testing. Based on the submitted diagnosis code(s), claims submitted for services provided on and after September 10, 2019 to patients enrolled in Horizon BCBSNJ…

Change to National Drug Code (NDC) Reimbursement Policy for Outpatient Facilities in UHC

Change to National Drug Code (NDC) Reimbursement Policy for Outpatient Facilities in UHC

For dates of service on or after Nov. 1, 2019, the National Drug Code (NDC) policy for UnitedHealthcare Medicare Advantage plans, including all UnitedHealthcare Dual Complete plans, will be revised for drug-related codes in outpatient facilities. With this policy change, care providers who are contracted with us who submit claims for drug-related Healthcare Common Procedure…

BCBS Reimbursement Policy Update: Bundled Services-Professional

BCBS Reimbursement Policy Update: Bundled Services-Professional

Beginning with dates of service on or after November 1, 2019, new Inter-professional CPT codes 99451 and 99452 are not eligible for reimbursement when they are reported with another service or reported as a stand-alone service.  These codes have been added to policy section 1 of the Bundled Services and Supplies reimbursement policy. Source: https://providernews.anthem.com/indiana/article/reimbursement-policy-update-bundled-services-professional

New Molecular Pathology Guidelines

New Molecular Pathology Guidelines

The new Molecular Pathology coding guidelines changes will be effective from dates of service on and after Sept. 1, 2019. American Medical Association (AMA) guidance provides Claim Designation codes in the Molecular Pathology coding guidelines Gene Table that represent specific genes that are being tested. UnitedHealthcare will require care providers to append the AMA Claim…

CPT 90689

CPT 90689

CPT- 90689 Influenza virus vaccine, quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. Guidelines: The provider injects 0.25 mL of a four–strain influenza virus vaccine into a patient’s muscle to provide immunity to four forms of influenza, a severe and infectious respiratory disease; the vaccine is free of preservatives and derived…