HCPCS Modifiers List 2020: MA Ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical conditionMB Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient internet accessMC Ordering professional is…
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
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…
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 development by non-physicia Reference: Behavioral Health services Updates
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 codes changes are the results of newly available code sets and coding revisions to NCDs released separately. The revised NCD codes lists are, NCD110.18 Aprepitant: Contractors shall add J9036 as covered effective July…
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 retire the LCD based on national coverage determination (NCD) 220.4. Therefore, the related coding guideline article is also being retired. Effective date: The retirement of this LCD and related coding…
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 Phlebitisandthrombophlebitisofperonealvein I80.241 Phlebitisandthrombophlebitisofrightperonealvein I80.242 Phlebitisandthrombophlebitisofleftperonealvein I80.243 Phlebitisandthrombophlebitisofperonealvein,bilateral I80.249 Phlebitisandthrombophlebitisofunspecifiedperonealvein I80.25 Phlebitisandthrombophlebitisofcalfmuscularvein I80.251 Phlebitisandthrombophlebitisofrightcalfmuscularvein I80.252 Phlebitisandthrombophlebitisofleftcalfmuscularvein I80.253 Phlebitisandthrombophlebitisofcalfmuscularvein,bilateral I80.259 Phlebitisandthrombophlebitisofunspecifiedcalfmuscularvein I82.45 Acuteembolismandthrombosisofperonealvein I82.451 Acuteembolismandthrombosisofrightperonealvein I82.452 Acuteembolismandthrombosisofleftperonealvein I82.453 Acuteembolismandthrombosisofperonealvein,bilateral I82.459 Acuteembolismandthrombosisofunspecifiedperonealvein I82.46…
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,…
Looking for the United healthcare physical therapy billing guidelines? The modifier “GN, GO or GP” will be required on Always for “Therapy codes” to align with the Centers for Medicare & Medicaid Services (CMS). According to CMS, certain codes are “Always Therapy” services regardless of who performs them, and always require a therapy modifier —…
Looking for the CPT code for allergy testing? 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 limitations when the coverage criteria are met Reimbursement Information: Reimbursement for allergy testing services includes the following components, Supplies (e.g., sterile diluents,…