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… Read More »Horizon BCBSNJ Reimbursement Guidelines Changes in Outpatient Laboratory Claims
Aetna will no longer allow payment for below mentioned services, Effective from December 1, 2019. H2021 — community-based services, per 15 minutesH0032 — mental health service plan… Read More »Changes in Reimbursement Guidelines for Behavioral Health services
This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs effective from January 2020 These NCD coding changes are… Read More »Revised NCD list Effective from January’2020
LCD ID number: L36342 (Florida/Puerto Rico/U.S. Virgin Islands) After review of the local coverage determination (LCD) for screening and diagnostic mammography, it was determined to… Read More »Screening and Diagnostic Mammography — Retired Part A and Part B LCD
New Codes: D75.A Glucose-6-phosphatedehydrogenase(G6PD)deficiencywithoutanemia D81.30 Adenosinedeaminasedeficiency,unspecified D81.31 Severecombinedimmunodeficiencyduetoadenosinedeaminasedeficiency D81.32 Adenosinedeaminase2deficiency D81.39 Otheradenosinedeaminasedeficiency I26.93 Singlesubsegmentalpulmonaryembolismwithoutacutecorpulmonale I26.94 Multiplesubsegmentalpulmonaryemboliwithoutacutecorpulmonale I48.11 Longstandingpersistentatrialfibrillation I48.19 Otherpersistentatrialfibrillation I48.20 Chronicatrialfibrillation,unspecified I48.21 Permanentatrialfibrillation I80.24… Read More »2020 ICD-10 CM New Codes Effective from October 1, 2019
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… Read More »Stop Hepatitis B via HBsAg Screening in Pregnant Women
The modifier “GN, GO or GP” will be required on Always for “Therapy codes” to align with the Centers for Medicare & Medicaid Services (CMS).… Read More »United Healthcare Commercial Reimbursement Policy Updates effective from Sep 1st, 2019
Reimbursement for allergy testing is based on the number of each type of test performed by the same physician and is subject to the following… Read More »Allergy Test CPT Codes Limitation for Florida Blue
The HCPCS code set is updated quarterly. CR 11422 informs MACs and providers of the latest updates to specific drug/biological HCPCS codes. The October 2019 quarterly… Read More »HCPCS Codes Changes effective from October 1, 2019
New Codes: 0105U: Nephrology (chronic kidney disease), multiplex electrochemiluminescent immunoassay (ECLIA) of tumor necrosis factor receptor 1A, receptor superfamily 2 (TNFR1, TNFR2), and kidney injury… Read More »Upcoming CPT (NEW) Code Changes Effective from October 1, 2019